CMS backs off citizenship check for newborns

Responding to complaints about requirements under the Deficit Reduction Act that Medicaid recipients prove they are U.S. citizens, Centers for Medicare & Medicaid Services (CMS) officials said they are changing the requirement and will now say that all babies born in the United States whose deliveries are covered by Medicaid may remain eligible for Medicaid under certain circumstances for up to one year after their birth.

CMS acting administrator Leslie Norwalk said the Medicaid law provides that a child born to a mother receiving Medicaid will automatically be eligible for Medicaid for one full year if certain conditions are met.

Typically, according to CMS, newborn eligibility for Medicaid is "deemed" as long as the mother remains Medicaid-eligible and the child is a member of the mother's household. Under that deemed status, states don't make a new eligibility determination for the infant at the time of birth. Instead, eligibility is continued under the mother's status for the first year. After one year, the child's own eligibility must be established, including documenting citizenship.

Certain noncitizens, who ordinarily cannot be eligible for Medicaid, can be eligible for Emergency Medicaid services, including labor and delivery of a child. In a July 2006 interim final rule, CMS had said in such circumstances, the deeming process would not extend to infants born to mothers receiving Emergency Medicaid services. CMS now will issue a modified interim final rule allowing the deemed eligibility for an infant's first year of life. Documentation of eligibility would be required at redetermination in the same manner as for all deemed newborns, the notice said.

"Health care benefits are critical to the healthy development of newborn babies," Ms. Norwalk said in a statement. "We have heard the concerns raised and are taking action to ensure that newborns in similar circumstances are treated the same under Medicaid eligibility rules. We intend to modify the documentation requirements to put all babies born in the United States whose deliveries are covered by Medicaid on an equal footing."

Responding to the announcement, Sen. Jeff Bingaman (D-NM) said, "I'm glad the administration has taken this small step to fix a problem that it created. But we have a long way to go before the larger issue of citizenship documentation is resolved." And Sen. Chuck Grassley (R-IA), who has introduced legislation to ensure that all eligible infants born in the United States receive Medicaid coverage, said the CMS announcement was "a positive step" and added, "I look forward to watching CMS smoothly implement this rule."

Washington Gov. Chris Gregoire, who has filed a federal lawsuit against the citizenship requirements, said, "The Constitution could not be more clear: Babies born in the U.S. are citizens, regardless of who their parents are."