Department of Health and Human Services; Centers for Medicare and Medicaid Services: Medicaid Program; Citizenship Documentation Requirements
Highlights
GAO reviewed the Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) new rule on the Medicaid Program's citizenship documentation requirements. GAO found that (1) the final rule implements the statutory requirement that states obtain satisfactory documentary evidence of a Medicaid applicant's or recipient's citizenship and identity and provide states with guidance on the types of documentary evidence that may be accepted; and (2) CMS complied with applicable requirements in promulgating the rule.
Department of Health and Human Services; Centers for Medicare and Medicaid Services: Medicaid Program; Citizenship Documentation Requirements, GAO-07-1112R, July 26, 2007
The Honorable Max Baucus
Chairman
The Honorable Charles E. Grassley
Ranking Minority Member
Committee on Finance
The Honorable John Dingell
Chairman
The Honorable Joe Barton
Ranking Minority Member
Committee on Energy and Commerce
House of Representatives
Subject: Department of Health and Human Services; Centers for Medicare and Medicaid Services: Medicaid Program; Citizenship Documentation Requirements
Pursuant to section 801(a)(2)(A) of title 5, United States Code, this is our report on a major rule promulgated by the Department of Health and Human Services; Centers for Medicare and Medicaid Services (CMS), entitled Medicaid Program; Citizenship Documentation Requirements (RIN: 0938-AO51). We received the rule on
The final rule implements the statutory requirement that states obtain satisfactory documentary evidence of a Medicaid applicant's or recipient's citizenship and identity. This final rule provides states with guidance on the types of documentary evidence that may be accepted.
Enclosed is our assessment of the CMS's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. Our review indicates that CMS complied with the applicable requirements.
The final rule has an announced effective date of
If you have any questions about this report, please contact Michael R. Volpe, Assistant General Counsel, at (202) 512-8236. The official responsible for GAO evaluation work relating to the subject matter of the rule is Marjorie Kanof, Managing Director, Health Care. Ms. Kanof can be reached at (202) 512-7114.
signed
Robert J. Cramer
Associate General Counsel
Enclosure
cc: Ann Stallion
Regulations Coordinator
Department of Health and
Human Services
ENCLOSURE
REPORT UNDER 5 U.S.C. sect. 801(a)(2)(A) ON A MAJOR RULE
ISSUED BY THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES;
CENTERS FOR MEDICARE AND MEDICAID SERVICES
ENTITLED
"MEDICAID PROGRAM; CITIZENSHIP
DOCUMENTATION REQUIREMENTS"
(RIN: 0938-AO51)
(i) Cost-benefit analysis
CMS concluded that this rule will result in $80 million less spent by the federal government and $60 million less spent by state governments per year for the next 5 years. Because the total is greater than $100 million per year, this is a significant rule. The regulatory impact statement did not account for the administrative costs on the states. With respect to administrative costs, CMS states that it provides federal match for administrative expenditures. CMS expects states to experience higher administrative costs during the first year of implementation as they adjust to the new requirements and expects these costs to decrease in later years as current recipients meet the requirements and only new applicants are required to submit documentation.
(ii) Agency actions relevant to the Regulatory Flexibility Act, 5 U.S.C. sections 603-605, 607, and 609
CMS did not prepare an analysis under the Regulatory Flexibility Act because it determined that this rule would not have a significant economic impact on a substantial number of small entities.
(iii) Agency actions relevant to sections 202-205 of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. sections 1532-1535
CMS concluded that this rule will have no consequential effect on state, local, or tribal governments or on the private sector.
(iv) Other relevant information or requirements under acts and executive orders
Administrative Procedure Act, 5 U.S.C. sections 551 et seq.
This final rule was preceded by an interim final rule and a comment period. The interim final rule was published on
CMS found good cause under section 553 of title 5 to make this regulation effective immediately because to delay implementation of this final rule would be contrary to the public interest as states would not have immediate authority to accept additional documentary evidence and, therefore, some applicants might be denied Medicaid.
Paperwork Reduction Act, 44 U.S.C. sections 3501-3520
CMS solicited comments on the information collection requirements of this final rule. CME determined that sections 435.406 and 436.406 will each take individuals 10 minutes to complete and states 5 minutes to verify.
Statutory authorization for the rule
The Deficit Reduction Act of 2005 created the requirement that states obtain satisfactory documentary evidence of a Medicaid applicant or recipient's citizenship and identity. Pub. L. No. 109-171, sect. 6036, 120 Stat 4, 80 (
Executive Order No. 12,866
CMS concluded that this rule will result in $80 million less spent by the federal government and $60 million less spent by state governments per year for the next 5 years. Because the total is greater than $100 million per year, this is a significant rule.
Executive Order No. 13,132 (Federalism)
CMS states that some states are already reviewing documents as would be required by this rule and concludes that this rule would create little or no burden for those states. CMS concludes that this rule will not overburden other states, although it will result in some increase in the burden on eligibility workers, because Medicaid eligibility workers are trained and skilled in the review of documents related to income and identification.