DAR File No. 40375

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-302-3

Citizenship and Alienage

Notice of Proposed Rule

(Amendment)

DAR File No.: 40375
Filed: 05/02/2016 10:20:34 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to provide Medicaid coverage to lawfully present alien children.

Summary of the rule or change:

This amendment allows alien children who are lawfully present and under 19 years of age to receive Medicaid coverage.

State statutory or constitutional authorization for this rule:

• Pub. L. No. 111-148
• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because funding for this coverage is 100% federal match.

local governments:

There is no impact to local governments because they neither fund nor make Medicaid eligibility determinations.

small businesses:

Small businesses may see a nominal increase in annual revenue, but there is no data to estimate a total amount.

persons other than small businesses, businesses, or local governmental entities:

Medicaid providers may see a nominal increase in annual revenue, but there is no data to estimate a total amount. Medicaid recipients who qualify under this provision may also see minimal out-of-pocket savings, but there is no data to estimate how much those savings would be.

Compliance costs for affected persons:

A single Medicaid provider may see a nominal increase in annual revenue, but there is no data to estimate a total amount. A Medicaid recipient who qualifies under this provision may also see minimal out-of-pocket savings, but there is no data to estimate how much those savings would be.

Comments by the department head on the fiscal impact the rule may have on businesses:

There will be a slight fiscal impact on business in that Medicaid providers may see a small increase in revenue for provision of additional services.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2016

This rule may become effective on:

07/01/2016

Authorized by:

Joseph Miner, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-302. Eligibility Requirements.

R414-302-3. Citizenship and Alienage.

(1) The Department incorporates by reference 42 CFR 435.406 October 1, 2012 ed., which requires applicants and recipients to be United States (U.S.) citizens or qualified aliens and to provide verification of their U.S. citizenship or lawful alien status.

(2) The Department elects to cover applicants and recipients who are under 19 years of age and lawfully present as defined in 42 U.S.C. 1396b(v) and 42 U.S.C. 1397gg(e)(1), and referenced in Section S89 of the Utah Medicaid State Plan.[The definitions in R414-1 and R414-301 apply to this rule.]

(3) The Department shall decide if a public or private organization no longer exists or is unable to meet an alien's needs. The Department shall base the decision on the evidence submitted to support the claim. The documentation submitted by the alien must be sufficient to prove the claim.

(4) One adult household member must declare the citizenship status of all household members who will receive Medicaid.

(5) A qualified alien, as defined in 8 U.S.C. 1641 who was residing in the U.S. before August 22, 1996, may receive full Medicaid, Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), or Qualifying Individuals (QI) services.

(6) A qualified alien, as defined in 8 U.S.C. 1641 newly admitted into the U.S. on or after August 22, 1996, may receive full Medicaid, QMB, SLMB, or QI services after five years have passed from the person's date of entry into the U.S.

(7) The Department accepts as verification of citizenship documents from federally recognized Indian tribes evidencing membership or enrollment in such tribe including those with international borders as required under Section 211(b)(1) of the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3, or as prescribed by the Secretary.

(8) The Department provides reasonable opportunity for applicants or clients to present satisfactory documentation of citizenship as required under Section 211(b)(2) of the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3.

(9) The Department considers that an infant born to a mother who is eligible for Medicaid at the time of the infant's birth has provided satisfactory evidence of citizenship. The Department does not require further verification of citizenship for the infant as required under Section 211(b)(3) of the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3.

(10) The Department adopts and incorporates by reference 42 CFR 435.949 and 42 CFR 435.952, October 1, 2012 ed.

(a) The Department shall verify citizenship and immigration status requirements through the Federal Data Services Hub or through other electronic match systems approved by the Secretary.

(b) If the Department cannot verify citizenship or immigration status through an electronic match system or the electronic data is not reasonably compatible with the client statement, the client must provide verification of citizenship and identity as described in 42 CFR 435.407.

 

KEY: state residency, citizenship, third party liability, Medicaid

Date of Enactment or Last Substantive Amendment: [September 1, 2015]2016

Notice of Continuation: January 23, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-3