Bazelon Center Mental Health Policy Reporter

June 23, 2006

In this issue:

How Medicaid Recipients Must Demonstrate U.S. Citizenship

Also Newsbytes on

• Increased Cost-Sharing by Medicaid Beneficiaries
• Criminal Justice and Mental Health Collaboration Grants
• Progress on Mental Health Services for Older Americans
• Children's Mental Health Bill
• Hearing on Mental Health Services

And: How You Can Help Produce a Voting Rights Guide.

States Given Guidance on Documenting Citizenship

After July 1, 2006, all new Medicaid applicants and all Medicaid beneficiaries undergoing their first redetermination will have to demonstrate their United States citizenship under the requirement set forth in the Deficit Reduction Acts (P.L. 109-171) (see the Bazelon Center's March 21, 2006 Mental Health Policy Reporter). States must implement this requirement in order to receive federal Medicaid matching funds.

On June 9, the Centers for Medicare and Medicaid Services (CMS) issued guidance to state Medicaid directors in a letter and accompanying fact sheet, also available on the CMS website. The materials specify what documents can be used to verify citizenship and prove identity.

The documents are listed in a hierarchy (primary, secondary, etc.), starting with a U.S. passport or naturalization certificate as key to verifying both citizenship and identity. A second level, for which separate proof of identity is required, includes a birth certificate or adoption decree or a record of military service that shows a U.S. place of birth. Other documents such as hospital-admission records or affidavits can be used only in rare circumstances, when no other source is available.  

Many Questions Remain

The guidance, released only a few weeks before the implementation date, leaves many questions unanswered. It has drawn criticism from advocates, who find it not sufficiently flexible to ensure that eligible individuals get access to Medicaid and existing beneficiaries maintain coverage.

Concerns have also surfaced about financial costs, delays and other barriers that will impede access. The Consortium for Citizens with Disabilities (CCD) has sent a letter to Health and Human Services Secretary, Michael Leavitt, urging clarification of the requirements in three areas in order to assist individuals with disabilities in gaining access to Medicaid services and supports. The letter asks CMS to 1) broaden the list of documents that can be used to establish identity once citizenship is documented; 2) specify procedures that will encourage the use of data matches to relieve the financial and logistical burden on the applicant or beneficiary; and 3) allow parity between legal non-citizens and citizens so applicants can be eligible for Medicaid for a reasonable period while they are obtaining their documents. The Bazelon Center, a member of CCD, endorsed the letter.

CMS has stated that it plans to release interim final regulations on the citizenship requirements before July 1. 

What Advocates Can Do Now

Even before release of the interim final rules, state Medicaid directors need to hear from advocates for people with disabilities with questions about how they plan to implement the new requirement and with expressions of concern about issues like those articulated in the CCD letter.

Newsbytes

CMS Releases Cost-Sharing Guidance

On Friday, June 16, 2006, CMS released a letter to state Medicaid directors on a new state option to increase premiums and cost-sharing for certain Medicaid recipients. The option, provided in the Deficit Reduction Act, allows states to impose new premiums and cost-sharing based on a recipient’s family income for services such as non-preferred medications and non-emergency use of a hospital emergency room. We believe the increased expense will hamper access to necessary services and supports for beneficiaries who rely on Medicaid for their health care. For details, see the March 2006 Bazelon Center Policy Reporter summary of the cost sharing provisions of the DRA.

CMS has stated that the letter is one in a series to explain the options available to states under the DRA and to simplify the administrative process for adopting these options through model state-plan amendments. The agency plans to issue further guidance through regulations.

Criminal Justice and Mental Health Collaboration Grant

On June 20, the House Appropriations Committee approved $5 million for the Mentally Ill Offender Treatment and Crime Reduction Act for fiscal year 2007. The grant program, sponsored by Senator Mike DeWine (R-OH) and Representative Ted Strickland (D-OH), was enacted on October 30, 2004 (P.L. 108-414) and first received federal funds ($5 million) in fiscal year 2006. The House has not yet voted on the FY ’07 appropriations bill, nor has a bill been considered in the Senate.

The program provides funds to help develop and expand an array of community-based alternatives to criminal and juvenile justice involvement, including crisis intervention teams and re-entry programs. The Department of Justice released its solicitation for the FY ’06 grant funds to the field in late spring and is likely to award grants this fall.

Progress on Seniors Mental Health

The House of Representatives passed the Senior Independence Act (H.R. 5293) on June 21, reauthorizing the Older Americans Act. The legislation also includes language from the Positive Aging Act (S. 2629, H.R. 1116), sponsored by Senators Hillary Rodham Clinton (D-NY) and Susan Collins (R-ME) and Representative Patrick Kennedy (D-RI) and Illeana Ros-Lehtinen (D-FL), and endorsed by the Bazelon Center and Mental Health Liaison Group, which includes development of multidisciplinary systems for the delivery of mental health screening and treatment referral-services for older adults. 

The inclusion of mental health language is a victory for mental health advocates, who have been deeply concerned about the growing need for such services among older Americans―a population with an extremely high rate of suicide. (For text of the bill, visit http://thomas.loc.gov and type H.R. 5293 in the search box.)

The Senate committee with jurisdiction is scheduled to consider the legislation next week.  

New Children's Mental Health Bill

On June 6, Senator Christopher Dodd (D-CT) introduced S. 3449, the Child and Adolescent Mental Health Resiliency Act of 2006. The bill would provide for a range of new grants, technical assistance centers and other modifications to SAMHSA programs. It is designed to help address the crisis in child mental health services identified by the New Freedom Commission on Mental Health and the U.S. Surgeon General. (Please visit http://thomas.loc.gov and search for S.3449 to read the legislative text.) 

Mental Health Hearings

Representative Sue Myrick (R-NC) has called for a hearing on mental health disorders before the House Energy and Commerce Committee on Wednesday, June 28. The hearing will discuss research advances on severe mental health conditions, such as depression, bipolar disorder and schizophrenia. The hearing will begin at 10:00am in room 2123 of the Rayburn House Office Building in Washington D.C. (see hearing notice).

Please Help Produce a Voting Rights Guide

In time for this November’s elections, the Bazelon Center and the National Disability Rights Network are developing a guide to the voting rights of people with mental disabilities for use by advocates and election officials. Personal accounts of problems and how they were resolved (if they were) help to illustrate the directions in such a guide. Have you, or has someone you know, ever faced problems in access to registration or voting because of a mental disability―real or perceived? If so, please tell us when and where (what state), whether the problem was with registration or voting, and how access was impeded. How did you or your advocate address the problem, and were you successful? Let us know whether you are willing to have your name used or if you prefer that, if we tell your story, we use only your initials. Send your account to voterguide@bazelon.org.