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Medicaid Eligibility Determinations and Associated Payments Based on Enrollees' Citizenship or Immigration Status

Announced on  | Last Modified on  | Project Number: OAS-26-02-002
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Individuals meet Medicaid eligibility criteria by satisfying certain Federal and State requirements related to income, residency, citizenship, immigration status, and documentation of citizenship. Specifically, eligibility for Medicaid coverage related to citizenship and immigration status is limited to U.S. citizens or nationals and qualified noncitizens. States must verify individuals' eligibility information, such as citizenship and immigration status, with the Social Security Administration and the Department of Homeland Security. Any discrepancy between an individual's attested citizenship or immigration status and the information verified by the State must generally be resolved within a 90-day timeframe known as the reasonable opportunity period. We will determine whether selected States determined Medicaid eligibility for enrollees based on citizenship or immigration status and claimed Federal Medicaid reimbursement in accordance with Federal and State requirements.

TIMELINE

  • December 15, 2025
    Announced
  • Today
    Office of Audit Services In-Progress
  • Est FY2027
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
-
Target Groups
-
Financial Groups
Medicaid