Medicaid Law Aimed At Illegal Immigrants Hits U.S. Citizens
According to a story in the New York Times today, "A new federal rule intended to keep illegal immigrants from receiving Medicaid has instead shut out tens of thousands of United States citizens who have had difficulty complying with requirements to show birth certificates and other documents proving their citizenship, state officials say." Other excerpts from the story:
Under a 2006 federal law, the Deficit Reduction Act, most people who say they are United States citizens and want Medicaid must provide "satisfactory documentary evidence of citizenship," which could include a passport or the combination of a birth certificate and a driver's license.
Some state officials say the Bush administration went beyond the law in some ways, for example, by requiring people to submit original documents or copies certified by the issuing agency.
The numbers alone do not prove that the decline in enrollment was caused by the new federal policy. But state officials see a cause-and-effect relationship. They say the decline began soon after they started enforcing the new rule. Moreover, they say, they have not seen a decline in enrollment among people who are exempt from the documentation requirement -- for example, people who have qualified for Medicare and are also eligible for Medicaid.
Medicaid officials across the country report that some pregnant women are going without prenatal care and some parents are postponing checkups for their children while they hunt down birth certificates and other documents.
The principal authors of the 2006 law were Representatives Charlie Norwood and Nathan Deal, both Georgia Republicans. Mr. Norwood died last month.
Chris Riley, the chief of staff for Mr. Deal, said the new requirement did encounter "some bumps in the road" last year. But, he said, Mr. Deal believes that the requirement "has saved taxpayers money." The congressman "will vigorously fight repeal of that provision" and will, in fact, try to extend it to the Children's Health Insurance Program, Mr. Riley said. He added that the rule could be applied flexibly so it did not cause hardship for citizens.
In general, Medicaid is available only to United States citizens and certain "qualified aliens." Until 2006, states had some discretion in deciding how to verify citizenship. Applicants had to declare in writing, under penalty of perjury, whether they were citizens. Most states required documents, like birth certificates, only if other evidence suggested that a person was falsely claiming to be a United States citizen.
In Virginia, health insurance for children has been a top priority for state officials, and the number of children on Medicaid increased steadily for several years. But since July, the number has declined by 13,300, to 373,800, according to Cindi B. Jones, chief deputy director of the Virginia Medicaid program.
"The federal rule closed the door on our ability to enroll people over the telephone and the Internet, wiping out a full year of progress in covering kids," Ms. Jones said.
State and local agencies have adopted new procedures to handle and copy valuable documents. J. Ruth Kennedy, deputy director of the Medicaid program in Louisiana, said her agency had received hundreds of original driver's licenses and passports in the mail.
Barry E. Nangle, the state registrar of vital statistics in Utah, said, "The new federal requirement has created a big demand for birth certificates by a group of people who are not exactly well placed to pay our fees." States typically charge $10 to $30 for a certificate.
