Implementing Medicaid citizenship documentation requirements in a family planning waiver: Oregon's experience

The Deficit Reduction Act (DRA) of 2005 mandated that Medicaid applicants provide proof of citizenship in order to be made eligible. This presentation describes the implementation and effects of the citizenship documentation requirements in Oregon's family planning Medicaid waiver, FPEP (Family Planning Expansion Project). In collaboration with panel members, comparisons will also be made to the experiences of other states with similar family planning waivers.

In Oregon, the citizenship documentation requirements were implemented with two other eligibility changes: mandatory collection of Social Security Numbers for teens and denial of coverage to individuals with creditable insurance. Oregon also designed a unique strategy to reduce the burden of citizenship documentation for applicants and providers: a 100% state-funded 'one-time exception visit,' for applicants who meet all eligibility criteria apart from documentation of citizenship.

Since implementation of these eligibility changes, FPEP visits have declined by 30% overall and by 43% among youth under 18 years. Contrary to some expectations, clients of different races, ethnic backgrounds, and poverty levels have been equally affected. An average of 1,200 one-time exception visits occur each month, assuring timely access to contraception for individuals and generating vital operating revenue for safety-net providers. Over 60% of patients who have a one-time exception visit voluntarily return within 6 months to submit the citizenship documentation that they were unable to provide initially. The long-term effects of the DRA and other eligibility changes on reproductive health outcomes (e.g. teen pregnancy) and safety-net capacity remain to be seen.