On July 10, 2025, the United States Department of Health and Human Services (HHS) issued new guidance that requires health centers to verify that recipients of federally-funded services are either U.S. citizens or “qualified aliens.” 

The regulatory update expands the reach of existing law and reverses long-standing policy that had excluded health centers and other HHS services from the verification requirement. It includes some key exemptions for nonprofit charities and for immunization and disaster relief. 

The new guidance explains that HHS is changing its interpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which prohibits non-citizens who are not categorized as qualified aliens from receiving federal public benefits. Since 1998, HHS had taken the narrow stance that several of its services were not “federal public benefits” and so providers of those services did not have to verify the citizenship status of recipients.

Under the new guidance, HHS has updated the list of services that are deemed federal public benefits and, therefore, are only available to U.S. citizens or qualified aliens. The list now captures many services that were excluded before, including the Health Center Program. It also now includes Head Start, Health Workforce Programs (including grants, loans, and scholarships), and several mental health and substance abuse treatment programs. HHS says that the list it shared with the new guidance is not exhaustive, and that program-specific guidance will be issued to designate other programs as federal public benefits. 

What Providers Should Do

Unless the nonprofit charitable exception or the emergency care, immunization, or disaster relief exceptions apply, health centers that provide services through the HHS Health Center Program are now required to ensure that those who receive their services are U.S. citizens or qualified aliens as defined in 8 U.S.C. § 1641. According to the statute, a qualified alien is a person who has legal permission to reside in the U.S. under a specific set of laws, such as those that grant permanent residency, refugee, or asylum status to immigrants.

As to how providers should verify a person’s citizenship status, the new guidance says that HHS is not setting new requirements at this time. It leaves in place guidance from 1997, which instructs providers of federal public benefits to either request documentation of the recipient’s citizenship status or ask them to provide a written declaration of their citizenship status “under penalty of perjury.” The same guidance also instructs providers to verify that a person is not a qualified alien with U.S. Citizenship and Immigration Services before denying them benefits if they don’t believe the documentation provided is genuine. To ensure compliance with anti-discrimination laws, providers should ensure that they do not discriminate based on national origin, race, or disability when verifying status. 

The new guidance does give some verification instructions to providers. It advises providers to “pay heed to” national policy that prioritizes restricting the access of non-qualified aliens when conducting their verification processes and indicates that further guidance on verification is forthcoming.

Verification Exceptions 

Providers should also note that there are exceptions to PRWORA that allow some services to be provided without citizenship verification, including those services provided by nonprofit charitable organizations and certain emergency care, immunization, and disaster relief services. The nonprofit charitable organization exception requires the eligible organization be organized for charitable purposes (e.g., relief of the poor and distressed or underprivileged) and precluded from distributing any gains or profits to its members or owners. 

The guidance from 1997 instructs providers (like health centers) with questions about the scope of the exception to contact the federal, state or local agency overseeing the provider to obtain guidance. The 1997 notice also states that an exempt provider can choose to verify, but a health center’s choice not to verify cannot be penalized through cancellation of its grant or denial of reimbursement for benefit expenditures.

Additional HHS Updates Expected

New HHS policy broadens existing prohibitions against providing services to non-U.S. citizens, requiring additional providers to verify the citizenship status of persons served. HHS has not set new requirements that providers must meet in obtaining that verification, so providers can continue to rely on the 1997 guidance about documentation and written statements provided by recipients and exemptions to the documentation requirements.  However, the new guidance suggests that further updates from HHS will follow. 

If you have questions regarding this new guidance or the citizenship verification process, contact Peter Mellette, Harrison Gibbs, or Alex Owens of Goodman Allen Donnelly’s health care practice. 

We note with appreciation the assistance of Emma Skeen, William & Mary Law ’26, in the preparation of this advisory.