The Deficit Reduction Act (DRA) of 2005 (P.L. 109-171) attempted to reduce the federal budget deficit by implementing changes in a wide range of federal programs, including Medicaid. Among other changes to the Medicaid program, the DRA requires that all Medicaid recipients and future applicants prove their citizenship and identity, effective July 1, 2006, or at first subsequent redetermination (Centers for Medicare & Medicaid Services [CMS] 2006a).

Most states had less than five months to develop and implement procedures for complying with DRA citizenship documentation requirements. Federal guidance was issued just three weeks before the law took effect, and the guidance was stringent about what documents would be acceptable, although they were silent on the implications of noncompliance. Thus, states that had developed procedures prior to the guidance may have had to revise them to meet the federally established criteria.

In July 2006, evaluators interviewed 31 state Covering Kids & Families® (CKF) grantees to understand how states were implementing DRA citizenship requirements in Medicaid.

Key Findings:

• Most state CKF grantees said that before the DRA, people did not have to provide proof of identity or citizenship to qualify for Medicaid.
• Five states reportedly delayed implementation of the DRA citizenship requirements because of confusion caused by belated federal guidance.
• Twenty-two of the 31 states had issued procedures to address DRA citizenship and identity requirements in Medicaid; nine states had no procedures in place as of July 1, 2006.
• In all 22 states that had issued procedures on DRA documentation requirements, guidance to eligibility workers consisted primarily of a list of the newly required documents.
• State CKF grantees identified problems and concerns associated with DRA documentation requirements.
• Eighteen of the 31 state CKF grantees said that their state had not publicized the new DRA documentation requirements to consumers.