Medicaid rule adds exemption


Amid mounting frustration over a requirement that Medicaid recipients document their citizenship to obtain health benefits, the federal government has exempted nearly 8 million people from the new rule -- including about 150,000 elderly and disabled Marylanders.

Maryland health officials, who learned of the exemptions yesterday, expressed relief while noting there are still more than 550,000 poor Marylanders they are scrambling to educate on the new requirements, which were to have gone into effect July 1.

The Maryland Department of Health and Mental Hygiene has moved to delay implementation of the requirements until Sept. 1. Officials said that during the next two months they will work to ease the process for new enrollees and current enrollees who receive their health insurance through Medicaid.

Officials in Maryland and elsewhere have argued that the federal government did not give states enough time to implement the changes when it notified them in a letter dated June 9 -- three weeks before the initial deadline.

The rule, part of the Deficit Reduction Act signed into law by President Bush in February, aims to prevent undocumented immigrants from illegally accessing Medicaid benefits. Only citizens can lawfully receive Medicaid. But until now, applicants were not required to show passports, birth certificates or driver's licenses to apply.

Public health advocates have argued that it is unfair to force the nation's 50 million Medicaid recipients to prove their citizenship with documents they might not have and that would take time and money to obtain. They said the new guidelines would hurt those who need health care the most, such as children, elderly in nursing homes and the homeless.

On Thursday, the federal Centers for Medicare and Medicaid Services responded with new guidelines saying the nation's 8 million elderly and disabled Medicaid recipients who also receive Supplemental Security Income from Social Security would be exempt because beneficiaries of those programs have documentation requirements of their own.

In addition, the agency said it would allow states to use multiple databases to verify the citizenship and identity of beneficiaries, without requiring a recipient to hand over the documents.

For instance, the initial procedure required Medicaid applicants to produce both proof of citizenship and identity, with passports or birth certificates and medical records, among others.

Now, Maryland health officials will be able to use other state databases to verify such information as birth certificates and school records to determine eligibility, said Charles Lehman, who oversees eligibility issues in the state's Medicaid office.

"That might take a significant chunk of people off the list, who would have had to provide documentation," he said.

"It's still going to be tight to try to get all of this done in basically two months' time," he said. "We have our work cut out for us."

Kathleen Westcoat, president of Baltimore HealthCare Access Inc., which assists Baltimore's nearly 200,000 Medicaid enrollees, worries that despite the new federal guidelines and the additional time to implement them, people born outside of Maryland -- whose vital information cannot be checked with state databases -- will have no choice but to supply documents.

Westcoat said she is particularly concerned about elderly nursing homes residents who solely receive Medicaid. They, too, will have to prove their citizenship with documentation, she said.

"The changes are a good thing, but they don't really address those vulnerable people to the extent that I think we need to," she said.

Meanwhile, it's unclear what impact the new guidelines will have on a class-action lawsuit filed in federal court last week.

A judge heard initial hearings in the lawsuit yesterday and scheduled a status hearing for July 28.

Attorneys for plaintiffs said in a statement that vulnerable populations are still at risk of losing their insurance.

"There are still 40 million Americans who must comply with this law or face loss of coverage," said John Bouman, an attorney with the Sargent Shriver National Center on Poverty Law, whose lawsuit claims the new requirements are unconstitutional. "This includes disaster victims, the homeless, the mentally disabled and foster children."

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