WASHINGTON — Scrambling to keep millions of low-income U.S. citizens from unintentionally being denied healthcare benefits, federal officials Thursday proposed alternatives that states can use to carry out a controversial law requiring Medicaid recipients to prove their citizenship.
The law, which took effect July 1, requires new applicants and current beneficiaries to submit such documents as passports to establish their legal right to benefits. But many of the 50 million people covered by Medicaid lack such documentation, and advocates and state officials feared that as many as 3 million could lose benefits.
In California, where Medicaid is known as Medi-Cal, experts estimated that about 650,000 of nearly 7 million beneficiaries might not be able to comply with the law's requirements. They included people with severe disabilities and many nursing home residents.
Advocates say it is not unusual to find people in their 70s and 80s who lack birth certificates, particularly if they were born poor and in small towns.
"We want to make sure people eligible for Medicaid get their benefits, and we want to do it without imposing additional burdens on the states," Mark McClellan, administrator of the Medicaid and Medicare programs, said in announcing the anxiously anticipated regulations.
"This recognizes the diversity of individuals and provides a range of ways citizenship status may be documented," he explained.
The regulations, which would become final later this summer, would exempt from the documentation requirements some 8 million elderly and disabled people who are enrolled in Medicare or receiving Supplemental Security Income through Social Security.
Additionally, people who are making a "good faith effort" to prove their citizenship would not face loss of coverage.
Instead of requiring beneficiaries to take steps such as obtaining a passport, states could use several different kinds of government program databases to establish eligibility.
In rare cases where no documentation of citizenship can be found, sworn affidavits from the beneficiary and at least one other person could be used.
Moreover, states that provide Medicaid coverage for legal immigrants would be able to keep using their current procedures.
Advocates for the poor and the elderly reacted cautiously to the announcement late Thursday afternoon. California officials said they needed more time to analyze the 94-page regulation.
