Utah is one of 47 states that allows self-declaration of U.S. citizenship on Medicaid applications, according to a new federal report.

The findings by the U.S. Department of Health and Human Services Office of Inspector General aren't troubling to federal Medicaid officials or those in Utah.

"I think we have an excellent system," said Jacky Stokes, health program manager of the Utah Department of Health. "There's absolutely nothing to tell me that we don't."

Stokes said while people can self-declare their citizenship on applications without providing proof, verification is asked for "if something doesn't ring true."

She added that an automatic auditing process is used to verify the eligibility of applicants. The process is generally a targeted sampling, for example, zeroing in on nursing home cases, she said.

In a letter of response, Centers for Medicare & Medicaid Services (CMS) administrator Mark B. McClellan said the report "reinforces our current policy approach to provide states with the flexibility to enroll eligible individuals while preserving program integrity."

Medicaid is a federal and state health-care program for low-income children up to age 21, pregnant women, disabled and elderly individuals. Only U.S. citizens and certain categories of legal immigrants are eligible for the benefits.

Mary Kahn, spokeswoman for CMS, said self-declaration helps streamline the process to make it easier for people to get the health care they need.

"The more difficult a state makes it to apply for and obtain Medicaid benefits, the more people who might otherwise be entitled won't get it," she said. "A burdensome application can be a barrier to care. . . . We do not have any data that shows fraudulent claims of citizenship are a problem for states."

For those states that allow self-declaration of citizenship, Utah was among 44 states that require evidence of citizenship if statements seem questionable and among 20 states that verify the accuracy of some U.S. citizenship statements as part of their post-eligibility quality-control activities.

The report recommends CMS strengthen its quality controls. It also notes that some states accept as evidence of citizenship documents that aren't accepted by CMS or the Social Security Administration, such as school records or family Bibles. It recommends issuing a complete list of citizenship evidence states can reference and exploring allowing state Medicaid staff to use citizenship verifications from other Medicaid-related programs.

McClellen's letter said the review recommends "steps for improving safeguards that CMS and states have already taken."

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E-mail: dbulkeley@desnews.com