New York State is one of only four states in the nation that already requires documentation of citizenship for Medicaid applicants (the others are Georgia, Montana and New Hampshire), and the only state with significant implementation experience. New York's citizenship documentation requirement has been in place since the mid-1970s, and provides a solid base of experience that can inform the implementation of the new documentation requirement in the Deficit Reduction Act of 2005, as well as planning in state Medicaid programs that will be documenting citizenship for the first time.