A program intended to prevent illegal immigrants from fraudulently applying for Medicaid will not begin until late September in North Carolina, two months after its scheduled start date, officials said.

Until then, people applying for the federal health insurance will not be required to prove citizenship with documentation. They will only be asked whether they are U.S. citizens, as the old policy required, said Mark Benton, senior deputy director for the state Division of Medical Assistance. Questionable applications will be examined further.

"Our intent is not to lose recipients but to keep the folks that should be on [Medicaid]," he said.

The changes, part of a federal law approved in February to curb fraud, require new and renewing Medicaid applicants to prove their citizenship status through birth certificates, passports or other approved documents.

In some cases, two written affidavits affirming a person's citizenship status would be accepted.

The changes will save Medicaid about $735 million by 2015, according to Congressional Budget Office estimates. Critics say the program could hurt legitimate applicants and will do little to curb fraud.

The program was scheduled to begin nationwide July 1. Benton blamed the delay in North Carolina on the federal agency responsible for Medicaid, which left states just three weeks to put changes in place after spending four months compiling instructions.

Medicaid is a federal program that provides health insurance to low-income families and individuals. States help manage the program.

Critics of the changes say that states will have to absorb additional costs and that legitimate Medicaid recipients could get cut from the program.

Up to five million Medicaid recipients are at risk of losing coverage nationally, according to the Center on Budget and Policy Priorities, a Washington think tank.

Center health analyst Leighton Ku said up to 10 percent of North Carolina's 1.5 million recipients don't have a birth certificate or passport, the main forms of necessary documentation under the new rules.

Hospitals also are concerned the changes will result in more uninsured patients whose bills aren't paid by Medicaid.

"If you're not eligible, [we] don't get reimbursed," said Moses Cone Health System spokesman Doug Allred.

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