Congress Confirms Plaintiffs' Interpretation of the Medicaid Citizenship Documentation Requirement

December 15, 2006
Contacts: John Bouman, Attorney for the Plaintiff, 312.961.3862
Rikeesha Cannon, 312.368.2677

(Chicago)--Congress undid the U.S. Department of Health and Human Services' misreading of an early 2006 federal law change in Medicaid citizenship documentation requirements for foster children and children receiving adoption assistance by passing H.R. 6111 on December 9. Congress's action confirms that it always intended to exempt these children from the citizenship documentation requirements included in the Deficit Reduction Act of 2005 and that the plaintiffs in Bell v. Leavitt, a nationwide class action challenging the agency's directions to the state Medicaid programs that such children must submit specified documents establishing citizenship, were right about the law.

Section 405 of H.R. 6111 makes several "technical corrections" on the Deficit Reduction Act of 2005, which Congress passed early in 2006. Those corrections stipulate that Congress intended to exempt certain groups of citizens, including foster children and children receiving adoption assistance, from the new citizenship documentation requirements. In response to the Bell v. Leavitt lawsuit, filed on June 28, 2006, Health and Human Services Secretary Michael Leavitt had already changed his position and exempted several other groups of citizens, such as people receiving Supplemental Security Income benefits, from the new documentation requirements. He had, however, refused to read the Deficit Reduction Act to exclude foster and adoption assistance children. The Bell plaintiffs had sought from the federal court in Chicago a preliminary injunction directing the Secretary to exempt them. In a recommended decision issued on December 8, U.S. Magistrate Judge Michael Mason agreed that the agency was misreading the law but declined to issue an injunction because of insufficient proof that children were being harmed at this time. Attorneys for the Bell plaintiffs and the agency are discussing how the agency can best and most quickly advise the states that they must exempt foster and adoption assistance children from the citizenship documentation requirments and that the states are authorized to set their own procedures for verifying the citizenship status of foster children. When the children's legal claim is resolved favorably, the Bell lawsuit will continue on the remaining issues, including that the new citizenship documentation requirements do not apply to Medicaid recipients and that the agency's narrow list of acceptable documents is illegal.

John Bouman, one of the attorneys for the plaintiffs, said: "We are very pleased that Congress has now affirmed what we said all along--the citizenship rule does not apply to foster and adopted children. A half million very vulnerable children are now spared from the government's unnecessary threat to their health care. We still believe that the citizenship documentation rule also unconstitutionally threatens the health care of every Medicaid recipient. That issue remains before Judge Guzman, and we are awaiting his ruling on whether the case can proceed."

Additional Materials of Interest

Press Release (December 15, 2006) (PDF format)

Press Release (September 20, 2006) (PDF format)

Press Release (July 7, 2006) (PDF format)

Press Release (June 28, 2006) (PDF format)

Case file in Bell v. Leavitt

John Bouman biography (PDF format)

Margaret Stapleton biography (PDF format)

"New Medicaid law is called a threat; Illegal immigrant fraud was target" Chicago Tribune, June 28, 2006

"Abusing Citizens and Wasting Money: Feds Issue Guidance on the Citizenship Documentation Requirement for Medicaid" (Poverty Action Report, June 15, 2006)

The Centers for Medicare and Medicaid Services, or CMS, the federal agency in charge of the Medicaid program, last week issued guidance to all state Medicaid directors on how they are to administer the new requirement that all Medicaid applicants and recipients who are U.S. citizens must document their U.S. citizenship. The CMS guidance clarifies and in many ways softens the potential harmful impact of the law, but the new law nevertheless persecutes citizens and wastes tax dollars.

"Medicaid Beneficiaries Now Must Prove That They Are Citizens" (Poverty Action Report, May 15, 2006)

Medicaid applicants and enrolles will have to prove that they are citizen in order to qualify for benefits. The Deficit Reduction Act requires such proof beginning July 1 this year. Advocates should be aware of resources available to assist Medicaid beneficiaries in proving that they are citizens.

"Birth Certificate or Passport Requirement Threatens Health Coverage for Many" (Poverty Action Report, March 15, 2006)

The birth certificate or passport provision is not necessary to protect the Medicaid program from undocumented immigrants. Instead, it will hurt many defenseless citizens, mostly elderly and disabled minorities.