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

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.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
December 2025 CMS Medicaid Eligibility Determinations and Associated Payments Based on Enrollees' Citizenship or Immigration Status Office of Audit Services OAS-26-02-002 2026