A majority of states don't verify claims of U.S. citizenship by those seeking Medicaid (search), which creates the potential for illegal immigrants to access the health care program, an inspector general's report has found.

"The quality assurance checks aren't there. That's how we see it," said Jodi Nudelman, an acting regional inspector general for the Department of Health and Human Services. "And it's our sense the people may not be aware of that."

Federal law says that, with a few exceptions, a person must be a citizen to receive Medicaid benefits. States can accept a signed declaration as proof of U.S. citizenship. Forty-six states do.

Only Montana, New York, New Hampshire and Texas require applicants to submit documents verifying citizenship.

Of the states that allow self-declaration of citizenship before accessing Medicaid, 27 did not conduct subsequent auditing that would verify an applicant's statements were true.

One reason the federal government allows for self-declaration of citizenship with Medicaid is that it speeds access to health care.

The inspector general's report does not address to what extent there is a problem with illegal immigrants accessing Medicaid, only that the potential exists. Only one state, Oregon, has conducted an audit to determine how often "noncitizens" gained access to Medicaid.

Oregon's secretary of state reviewed a sample of 812 applications in 2002 and found that 25 were not citizens. The state estimated that it would cost an additional $2 million if 1 percent of the Medicaid rolls are not citizens.

The Centers for Medicare and Medicaid Services responded that it agreed that states should have systems in place to ensure the citizenship of applicants. However, it also noted that the IG's report raises only a potential problem.

"The report does not find particular problems regarding false allegations of citizenship, nor are we aware of any," CMS officials replied.

In some cases, newly arrived legal immigrants, as well as illegal immigrants, can lawfully access Medicaid, but such coverage is greatly limited to emergency care.