Nursing home providers have called on the government to be flexible in enforcing a Medicaid rule that begins July 1. The measure requires Medicaid enrollees to provide citizenship documentation before receiving services.

But many Medicaid beneficiaries who live in nursing homes, assisted living communities and other eldercare settings have cognitive impairments that might challenge their ability to comply, cautions Bruce Yarwood, president and CEO of the American Health Care Association.

The Department of Health and Human Services should consider grandfathering in residents, he wrote in a letter to the head of the agency. He also called on states to contact the Social Security Administration to establish citizenship for those already receiving Supplemental Security Income benefits. The department soon will release implementation guidelines and support materials for the law, according to Mark McClellan, administrator of the Centers for Medicare & Medicaid Services.