Under the Deficit Reduction Act President Bush signed this year, all states now require proof of citizenship to Medicare recipients.
While lawmakers say this is a way to save money and to prevent undocumented immigrants from receiving assistance, others are asking for a little leniency.
"The intent is not to shell out dollars."
Barren River Ombudsman Program Director Ruth Morgan is concerned the government's motive to save millions of dollars by 2010 will hurt.
"People will be denied care because they can't afford it or they won't have the appropriate proof of identification."
Now, a birth certificate plus drivers license or a passport for legal immigrants is required... something simple to the average citizen, but for the elderly, Ruth fears it could become a problem.
"The average age of nursing home resident is 83 ... they have memory problems."
660,000 Medicaid recipients lived in Kentucky in 2003.
That's 90 times the capacity of Diddle Arena.
Ruth says of that number there's no telling how many Kentuckians will be erased from the Medicaid rolls if they don't have proper identification.
She called some local nursing homes to see just how many this could affect ... they had mixed answers.
"One of them said that the majority of their residents couldn't come up with proof another says 25% could come up with birth certificate."
After July first, all new re-certifications and applicants will have to have proof of citizenship.
The Federal Medicaid Administrator says implementation guidelines and other materials would be released after he works with each state's medicaid directors on their flexibility.
(Office of Kentucky Legal Services Program)