U.S. citizens feel change in Medicaid

New requirement directed at illegal immigrants

March 12, 2007|By Robert Pear | Robert Pear,New York Times News Service

WASHINGTON -- A new federal rule intended to keep illegal immigrants from receiving Medicaid has instead shut out tens of thousands of U.S. citizens who have had difficulty complying with requirements to show birth certificates and other proof-of-citizenship documents, state officials say.

Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia have all reported declines in enrollment and traced them to the new federal requirement, which comes just as state officials around the country are striving to expand coverage through Medicaid and other means.

Under a 2006 federal law, the Deficit Reduction Act, most people who say they are U.S. 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 largest adverse effect of this policy has been on people who are American citizens," said Kevin W. Concannon, director of the Department of Human Services in Iowa, where the number of Medicaid recipients dropped by 5,700 in the second half of 2006, to 92,880, after rising for five years. "We have not turned up many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere else in Iowa," Concannon said.

Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid Services, said the new rule was "intended to ensure that Medicaid beneficiaries are citizens without imposing undue burdens on them" or on states.

"We are not aware of any data that shows there are significant barriers to enrollment," Nelligan said. "But if states are experiencing difficulties, they should bring them to our attention."

In Florida, the number of children on Medicaid declined by 63,000, to 1.2 million, from July 2006 to January of this year.

"We've seen an increase in the number of people who don't qualify for Medicaid because they cannot produce proof of citizenship," said Albert A. Zimmerman, a spokesman for the Florida Department of Children and Families. "Nearly all of these people are American citizens."

Since Ohio began enforcing the document requirement in September, the number of children and parents on Medicaid has declined by 39,000, to 1.3 million, and state officials attribute most of the decline to the new requirement. Jon Allen, a spokesman for the Ohio Department of Job and Family Services, said the state had not seen a drop of that magnitude in 10 years.

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 that the decline began soon after they started enforcing the new rule, and that they have not seen such a decline among Medicaid recipients who are exempt from the documentation requirement.

Wisconsin keeps detailed records listing reasons for the denial or termination of benefits. "From August 2006 to February of this year, we terminated benefits for an average of 868 people a month for failure to document citizenship or identity," said James D. Jones, the eligibility director of the Medicaid program in Wisconsin. "More than 600 of those actions were for failure to prove identity."

In the same period, Jones said, the state denied an average of 1,758 applications a month for failure to document citizenship or identity. In 1,100 of those cases, applicants did not provide acceptable proof of identity.

"Congress wanted to crack down on illegal immigrants who got Medicaid benefits by pretending to be U.S. citizens," Jones said. "But the law is hurting U.S. citizens, throwing up roadblocks to people who need care, at a time when we in Wisconsin are trying to increase access to health care."

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 seek birth certificates and other documents.

Rhiannon M. Noth, 28, of Cincinnati applied for Medicaid in early December. When her 3-year-old son, Landen, had heart surgery on Feb. 22, she said, "he did not have any insurance" because she had been unable to obtain the necessary documents. For the same reason, she said, she paid out-of-pocket for his medications, and eye surgery was delayed for her 2-year-old daughter, Adrianna.

The children eventually got Medicaid, but the process took 78 days, rather than the 30 specified in Ohio Medicaid rules.

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