MASSHEALTH CITIZENSHIP VERIFICATION GUIDELINES

MassHealth recently released a fact sheet on the state’s interpretation and plans to implement the new federal citizenship verification guidelines. Please see fact sheet here. The content is summarized below.

• Verification of citizenship and identity is a one-time activity. Members who have verified citizenship and identity satisfactorily should not be asked to do so again.

• The new Federal Law does NOT include changes for DOCUMENTED immigrants, who must continue to provide proof of their status when they apply for MassHealth.

• The law does NOT change eligibility for the UNDOCUMENTED, however, there is concern it will have a “chilling effect”. In order to comply with this new requirement, the Office of Medicaid has made some changes to the Virtual Gateway computer system. At least one of these changes to the Virtual Gateway will have a "chilling" effect on non- citizens applying for MassHealth. On the Immigration Status Information page, the term "undocumented" has been added to the drop- down menu of immigration statuses. Asking people directly if they are undocumented is likely to spark even more fear in immigrant communities about getting care at hospitals and health centers. MIRA is working with the Office of Medicaid to try to remove the term "undocumented" from this drop- down menu. MIRA has also heard from some providers that immigrant applicants are getting requests from MassHealth to verify their immigration status regardless of what they declare within the Virtual Gateway OR the paper MBR (MassHealth application).

  If you have any stories of immigrant applicants being fearful of applying for Free Care or MassHealth Limited and/or if you have stories of immigrants receiving requests for verification of their immigration status even thought they are eligible for Free Care or MassHealth Limited, or if you have any questions, please contact Carly Burton.

• MassHealth will use electronic data matching to the greatest extent possible and allowable to assist members with fulfilling this new requirement. The state will be matching all applications and redeterminations against the state’s Department of Transitional Assistance database. This means that an applicant or member who also receives Food Stamps or EAEDC will not be required to prove citizenship. The state will not require proof of citizenship for any applicants or members who also receive SSI or Medicare. The federal government has waived this requirement for these populations. The state will look to see if an applicant or member has ever been on one of these programs, and will use that historical information as proof of citizenship. The state's next step will be to establish additional electronic matches: With Department of Public Health Vital Records, to obtain birth certificates for all those born in Massachusetts. With the Department of Motor Vehicles, to obtain proof of identify for all those with MA drivers’ licenses. Once all matching capability is operational, the state expects to be able to verify citizenship for 75% of MassHealth applicants and members, thereby eliminating the need for them to provide documentation. Unfortunately, the state cannot access this information from other states.

• If members and applicants do not comply with the documentation process, the state will deny coverage for both MassHealth and Free Care.

Timeframes:

• New applicants: MassHealth coverage will not begin until all necessary documentation, including proof of citizenship and identity, is submitted within the necessary timeframes. MassHealth will inform applicants when documents are due - either 60 or 30 days, depending on coverage type.

• Time-limited presumptive coverage for pregnant women and children will not be delayed pending documentation of citizenship and identity, but this documentation must still be submitted within 60 days of application in order for MassHealth benefits to continue. Infants born to mothers on MassHealth will not be asked for verification until redetermination/renewal.

• Current members: MassHealth requires a redetermination of eligibility at least once each year. When a member’s redetermination is due, the member will be notified that they have either 60 or 30 days, depending on coverage type, to provide documentation of citizenship and identity. These timeframes may be extended if the member indicates to MassHealth that he or she is making a good faith effort to submit the documentation.

Watch for these errors- especially in these first months.

Massachusetts instituted the new MassHealth proof of citizenship requirements on July 17th, two weeks after the federal start date of July 1st. You may notice that most official state correspondence pertaining to this new policy still refers to the start date as July 1st, just to be in accordance with federal requirements. However, MassHealth has instructed providers that this new requirement applies only to applications submitted on or after July 17th.

Several hospitals and health centers have reported cases where the state is asking individuals who applied during the first two weeks of July for proof of citizenship documentation. This should not be happening; individuals who applied before July 17th are not expected to provide this documentation at this time. They will not be completely exempt from this requirement forever, but will most likely not be asked for documentation until their annual redetermination.

Providers have also reported several other issues with MassHealth's implementation of this, including cases where those who have already provided a passport are still being asked for proof of identity, even though additional verifications are not needed with a passport and cases where applicants who checked off that they were non-citizens are being asked for proof of citizenship.

Unfortunately, the state is anticipating some implementation issues and is still struggling to train all MassHealth staff on the new requirements. If you encounter any problems like these, please inform Kim Simonian of the MassHealth contact person so she may follow up.

Practical suggestions (from MIRA)

• Do not delay sending in an application for lack of citizenship or identity documentation—the Office of Medicaid may be able to supply proof through a data match.

• Send in the best proof available of citizenship and identity even if it is not the preferred form and keep a copy for your records.

• If you cannot obtain verification by the deadline, ask the Office of Medicaid for more time or other assistance; do not let a request for more information go unanswered.

• Put your request for assistance from the Office of Medicaid in writing and keep a copy for your records.

• Keep track of implementation problems and solutions and let advocacy organizations know about your experiences.

• States must also assist the homeless and other special populations who because of “incapacity of mind or body” would be unable to comply with documentation requirements in a timely manner.

• Citizens denied MassHealth because of the new requirement should appeal and seek legal services. To find legal services see: www.masslegalhelp.org.

Applicants may incur costs in obtaining this documentation. State budget language was passed that enables MassHealth members and applicants to obtain certified copies of citizenship and birth records from state agencies at no cost. No word yet on how this will work.

Phone Numbers for Documentation Assistance:

• To receive or renew a Passport: National Passport Information Center, U.S. Department of State: 1-877-487-2778

• For Certificate of Naturalization or Certificate of U.S. Citizenship: U.S. Department of Homeland Security: 1-800-375-5283 / TTY 1-800-767-1833

• For Massachusetts Birth Certificates: Registry of Vital Records and Statistics, Massachusetts Department of Public Health: 150 Mount Vernon Street, 1 st Floor, Dorchester, MA 02125-3105, 617-740-2600

• For a Massachusetts Driver’s License or Massachusetts ID card: Massachusetts Registry of Motor Vehicles: 617-351-4500 / TTY 617-536-7534 or 1-877-768-8833

• General questions: MassHealth Customer Service: 1-800-841-2900 / TTY 1-800-497-4648

Macro-Advocacy

For advocacy purposes it is helpful to document client problems.  If you want to pass on general experiences (i.e., without using identifying info), you can e-mail Kim Simonian (Partner's Community Benefits liaison to MassHealth).  She welcomes the "on the ground" perspective, and then can relay to Partners/MGH Administration, MassHealth, Mass Hospital Association, etc.,  as appropriate

If you have a client who is interested in getting directly involved in advocacy, contact Ellen Forman, LICSW, for the appropriate advocacy organizations.

07/06