The Centers for Medicare & Medicaid Services on Friday issued much-awaited guidelines for the new controversial Medicaid law that requires applicants to show proof of citizenship.

Applicants can use a written affidavit as proof when other forms of documentation cannot be obtained, according to the new guidelines. Two citizens who have specific knowledge of the Medicaid beneficiary’s citizenship status must sign the written affidavit, the guidelines say. Also, the affidavits “can only be used in rare circumstances,” a fact sheet on the guidelines says.

Providers have been skeptical of the new law, which takes effect July 1. They fear that many frail and cognitively impaired residents may not be able to locate the necessary documentation.

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