The Deficit Reduction Act of 2005 (DRA) is a large and far-reaching legislation that offers states opportunities to enact Medicaid reforms. Section 1903(x) of the DRA addresses citizenship and identity requirements for Medicaid recipients. Effective July 1, 2006, states are required, with respect to all Medicaid eligibility determinations on or after that date, to obtain satisfactory documentation of citizenship and identity from all applicants. As citizenship is unlikely to change once it is established, recipients are only required to provide this documentation one time, unless reasonable doubt is present to justify further inspection. Click on the link below for the list of acceptable citizenship documents.