Medicaid enrollees will be asked to prove citizenship.

Byline: David Steves The Register-Guard

MORE INFORMATION www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp

SALEM - Starting this week, recipients and applicants for such government services as Oregon Health Plan coverage and long-term elder care will have to prove their citizenship.

The requirement was imposed by Congress last year and takes effect Saturday.

Oregon Gov. Ted Kulongoski said Wednesday that while he is sympathetic to Congress' intent, carrying out the new requirement could prove costly and bureaucratic to the state and burdensome to Oregonians who are U.S. citizens.

In a prepared statement, the Democratic governor called it "yet another financial and workload burden the federal government has imposed on states with short notice and little thought of the impact on citizens."

Although the legislation passed last year, states learned about the proof-of-citizenship requirement on June 9, when the U.S. Centers for Medicare and Medicaid Services issued its rules on the matter.

About 450,000 Medicaid recipients in Oregon must show proof of citizenship when they enroll or re-enroll in Medicaid-funded programs, such as the Oregon Health Plan, county-provided family-planning services and long-term care.

The requirement won't hit everyone at once but will kick in as new applicants show up and as current enrollees seek to renew their benefits, which is required every six months.

Oregon Department of Human Services officials estimate as many as 70,000 Oregonians may be unable to immediately and readily provide proof of citizenship.

Acceptable proof includes a U.S. passport or a U.S. birth certificate, if an additional document proving identity is submitted, such as a current state driver's license or state-issued identification bearing the applicant's picture.

For a child younger than school age, a birth certificate must be accompanied by an affidavit signed by a parent, vouching for the identity of the child.

Kulongoski said he had instructed DHS to "make certain that no one who is eligible for Medicaid in Oregon will be hurt" by the new requirement.

The harm he envisions is that as people enroll or re-enroll - that latter being required every six months when their Oregon Health Plan benefits are up for renewal - they could be cut off for lack of citizenship proof.

To ease this, Kulongoski has instructed eligibility workers to help people track down their necessary documents, such as birth certificates, and to continue their benefits eligibility as long as they are actively searching for their citizenship proof, DHS spokesman Jim Sellers said.

Such steps are allowed under the CMMS rules, which say that benefits applicants "should be given a reasonable opportunity" to produce proof of citizenship, said Sellers, adding that federal regulators did not set a time limit.

The requirement is hitting states across the country. Many are taking a posture similar to Oregon's, vowing to continue serving people who can't immediately produce evidence of their citizenship. Some states are spending money to comply with the law. Arizona is spending $10.4 million in state and matching federal dollars to hire 130 eligibility workers.

Others, such as Alabama, are simply planning to deny services to people until they prove their citizenship.

The Congressional Budget Office has projected savings of $735 million during the next 10 years services are cut off to those who can't prove citizenship. It was included as part of legislation aimed at cutting federal Medicaid spending.

Sellers said Oregon had no plans to hire additional workers. It would not know what the added workload would be until 60 days after the new rules take effect.

Before the change, it was unlawful for noncitizens to receive Medicaid-funded services - except for a limited number of emergency-level services that are available to noncitizens with legal resident status. But Oregon was among the 46 states that complied with the minimum federal requirement: asking applicants to make sworn statements that they are citizens.

Sellers said Oregon is unable to determine how many people receiving Medicaid-funded services are noncitizens.

Kulongoski's campaign rival, Republican challenger Ron Saxton, doesn't have a problem with the workload or added bureaucracy imposed by the new requirements.

"I think the cost of documenting this is greatly outweighed by the eventual savings," said Saxton's campaign manager, Felix Schein. "The fact is we're providing massive amounts of benefits for people who aren't eligible for them."

Kulongoski, who is seeking re-election, faces Saxton and as many as four independent or minor-party candidates in the November election.