This move was mainly seen as an attempt to pre-empt a ruling by a federal judge who is scheduled to hold a hearing on Friday on a lawsuit challenging the new law which came into effect on July 1.
According to Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, more than 8 million of the 55 million Medicaid recipients would be "exempt from the new documentation requirement" because they had established their citizenship when they applied for Medicare or Supplemental Security Income.
Medicaid is financed jointly by the federal government and the state government. It provides health insurance for low-income people, including several people in nursing homes. Medicare provides health insurance for people who are 65 and older or disabled. Supplemental Security Income is a cash assistance program for people with very low incomes who are elderly, blind or disabled. The number of people who receive Medicare and Medicaid is about six million. In most states, people receiving Supplemental Security Income are entitled to Medicaid.
Dr. McClellan stated that the exemption would apply, for instance, to "people with mental retardation who have never worked and to many nursing home residents." The new law had brought forth criticism from many who said that it would be difficult for many people with mental retardation, Alzheimer's disease and other mental impairments to produce the documents needed to comply.
According to the law, anyone who has Medicaid coverage or applies for it must present "documentary evidence of citizenship."Earllier, over 40 states had accepted the applicants' written statements as proof of citizenship unless the claims seemed questionable. According to the rule declared by the administration on Thursday "Self-attestation of citizenship and identity is no longer an acceptable practice."
This new provision is part of the Deficit Reduction Act, signed by President Bush on Feb. 8. As Representative Charlie Norwood, Republican of Georgia, a principal author of the requirement said, this is meant to stop the "theft of Medicaid benefits by illegal aliens."
In an unusual preamble to the new rule, the Bush administration said it believed that Congress had intended to exempt Medicaid beneficiaries who were also receiving Medicare or Supplemental Security Income.
A spokesman for Representative Norwood, has said that the final rule "appears to provide an appropriate degree of flexibility" to Medicaid beneficiaries and to states.
Ronald F. Pollack, the executive director of Families U.S.A., a consumer group working with plaintiffs in the court case, said: "The exemption of seniors and people with severe disabilities from the citizenship verification requirement is a commendable development. But many other people who need health care the most and can't come up with the required documentation such as foster children and homeless people may still lose Medicaid coverage and join the ranks of the uninsured. This should be corrected."