Federal officials sent the following number of letters to new insurance customers in each state, urging them to produce citizenship documents to avoid their insurance being terminated.

Tennessee - 3,800

Georgia - 20,900

Alabama - 2,800

Source: U.S. Dept. of Health and Human Services

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Over 6 percent of health insurance buyers in Georgia who bought plans on the federal new marketplace now face losing that coverage if they do not produce documents proving their citizenship or immigration status, federal officials said Wednesday.

Meanwhile, over 2 percent of marketplace customers in Tennessee have yet to submit proper paperwork, along with nearly 3 percent of insurance buyers in Alabama.

People who have not yet responded to the federal queries must submit the documents by Sept. 5 or lose coverage Sept. 30.

The Affordable Care Act created the federal Health Insurance Marketplace, which allows people to buy plans that qualify for tax dollar-supported subsidies, depending on their income and household size.

More than 80 percent of those who signed up for such plans are getting subsidies to help pay for the insurance, The Associated Press has reported.

But people must prove they are in the country legally to be able to get the coverage.

Letters spelling out the federal ultimatum were sent out Tuesday after repeated requests for the documents via email, phone and mail, federal officials said.

Federal officials stressed that such a letter does not necessarily mean there is a problem with an individual's eligibility for enrollment; it just means more information is needed to verify that eligibility.

If the documents are not received, however, health insurance plans will be terminated "in order to ensure program integrity and protect taxpayer dollars."

The Obama administration said Tuesday that letters are going out to about 310,000 people nationwide.

Among the 36 states that have opted to have the federal government run the new marketplace, Georgia has the fourth-highest number of letters sent: 20,900.

The highest-ranking states were those with high Hispanic populations, the AP reported.

The letters are being sent in English and Spanish, federal officials said, and they are recruiting community health centers and other local leaders to get the word out about the deadline.

"Since this is an urgent matter, we are activating our networks on the ground to reach people directly in the communities where they live," said Marilyn Tavenner, administrator of the U.S. Center for Medicare and Medicaid Services.

Erlanger Health System, which has spearheaded enrollment efforts at local community health centers, said they have interpreters and counselors available to help people who may need assistance with enrollment problems.

But Katherlyn Geter, who oversees Erlanger's outreach, said counselors "have not seen any immigrant enrollees with concerns about their coverage being terminated."

Contact staff writer Kate Harrison Belz at or 423-757-6673.