The new provision is part of last year's Deficit Reduction Act, which President Bush signed into law in February. Despite a federal inspector general's report concluding that there was little fraud by noncitizens, supporters said the measure would ensure that Medicaid dollars go only to citizens or eligible immigrants.

One plaintiff is Alphonso DeShields, who was born in his parents' home in Spartanburg, South Carolina, a few months after World War I began. For five years, he has lived in a nursing home in Northwest Washington, D.C. He has a severe heart condition, cancer and other ailments.

"With respect to each of the documents" Medicaid would have him supply, the lawsuit states, "Alphonso DeShields possesses neither an original of such a document nor a copy of such a document certified by the original issuing agency."

District officials, like their counterparts in the states, have no choice but to comply; otherwise, federal Medicaid funds would be withheld. About $900 million would be at stake in the District alone.

Robert Maruca, head of the Washington, D.C., Medical Assistance Administration, said yesterday that he expects that many residents with a right to Medicaid will be unable to demonstrate their citizenship.

Among the plaintiffs in that case are Ruby Bell, 95, born in an Arkansas county that did not issue birth certificates until 1914, and George Crawford, 80, who is so incapacitated from strokes that he cannot speak. According to attorneys, the church members who care for Crawford in Illinois don't even know where to start looking for documents that would pass muster.

Until now, Medicaid recipients have declared their citizenship, under penalty of perjury, without having to show evidence of it. States have been able to demand substantiation in suspicious cases. No longer will that process suffice.

New applicants will be affected immediately and will be denied benefits until they offer proof of citizenship. Current recipients will not have to back up their declarations until their first annual reenrollment, when they will have 45 to 90 days to do so, depending on their circumstances.

Medicaid spokeswoman Mary Kahn said the federal Centers for Medicare and Medicaid Services had made "every concerted effort to ensure [the requirement is] not overly burdensome on beneficiaries." She declined to comment on the litigation.

In a June 9 memo to states, federal officials announced a hierarchy of documents that would be acceptable. Virtually all must be accompanied by a driver's license or something else establishing a person's identity -- another obstacle for young and old alike, critics stress. Medical, insurance or census records can be used under specific conditions. Entries in family Bibles don't qualify.

The provision "throws out a dragnet and says, 'All of you, all 50 million of you, need to come in here and document your citizenship whether we think there's a problem or not,' " said John Bouman, a lawyer with the Sargent Shriver National Center on Poverty Law.

On Capitol Hill Thursday, several members of Congress called for a delay in implementation. They said verification will effectively bar some Medicaid recipients from health care. Just how many is unclear. The Congressional Budget Office estimated that the requirement would cause 35,000 people, mostly illegal immigrants, to lose coverage by 2015 and lower Medicaid spending by $735 million over 10 years.

"We've been working pretty feverishly to try and figure out what this means," said Charles Lehman, director of medical care programs for the Maryland Department of Health and Mental Hygiene.

Stephanie Sivert, manager of Virginia's medical assistance program, said clients who are mentally disabled or homeless, living in institutional settings, often have made a complete break with their pasts.

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