Red tape delays healing

Requiring documents for Medicaid hurts poor, advocates say

June 17, 2007|By Gady A. Epstein | Gady A. Epstein,Sun Reporter

All Renell Francine Ray needed to stay on Medicaid was an original birth certificate and a valid state ID card that would prove she was a U.S. citizen and Maryland resident.

Producing those documents might have seemed simple enough to Congress when it decided to require them as a way to block illegal immigrants from using the nation's health insurer of last resort.

But in the world of bureaucrats and paperwork, Ray became entangled in a maddening Catch-22: To obtain her original birth certificate from Virginia, she needed a valid state ID; to obtain a valid state ID, she was told, she would need her original birth certificate.

As a result Ray, a diabetic suffering from gout and arthritis, has been struggling for months to get on Medicaid, one of thousands of Marylanders who have failed to qualify for the program since the new law went into effect last summer.

"I'm to the point where I'm frustrated, I'm really frustrated," said Ray, a Baltimore resident who is on five different medications.

"I don't think you should have to go through things like this."

Across the country, advocates and health officials say, hundreds of thousands of poor people who may be eligible for Medicaid have gone without it at least temporarily, having to scramble to get paperwork to prove where they were born and where they live.

"It's affecting so many legal citizens, so many people who were born and raised here, and they can't get it because these documents are just as difficult for them to get as anybody else," said Sadie A. Matarazzo, a social worker with Baltimore HealthCare Access Inc., which works with some of the city's Medicaid recipients.

Generally, very low-income U.S. citizens and legal immigrants with at least five years' residency are eligible for Medicaid, a federally subsidized health insurance program for the poor. Single adults without young children like Ray are generally not eligible unless they are deemed "medically needy," in which case they can qualify in Maryland if they earn roughly $20,000 a year or less.

Until last year, states, which administer the program, allowed people to simply declare their legal status, and no citizenship documents were necessary.

But Congress, concerned that illegal immigrants had easy access to the taxpayer-financed program, passed a law last year requiring states to get documentary proof of Medicaid applicants' legal status.

Supporters argue that it's only fair to ensure that those receiving government help are legally entitled to it, that in the past, any illegal immigrant could sign up rather easily for government-funded care.

But many states are finding that the law is also a barrier to tens of thousands, and likely hundreds of thousands, of poor citizens on their rolls.

That includes many children, for whom parents must track down the required paperwork.

"It's a large number of people, and the state officials are saying that most, if not almost all, of these people are U.S. citizens," said Donna Cohen Ross, who has researched the issue for the Washington D.C.-based Center on Budget and Policy Priorities.

Maryland health officials have worked to match up the state's half-million Medicaid recipients with state birth records in an effort that, though costly and time-consuming, has avoided unnecessarily rejecting tens of thousands of applications from lifelong Marylanders.

State officials have not kept track of how many people are losing Medicaid coverage because of the new law - or its effect on children.

The U.S.-born children of legal immigrants may be particularly vulnerable to the new rules, according to CASA of Maryland, an immigrant advocacy group that says some parents have reported difficulty getting local health officials to accept their children's birth certificates.

Maryland has experienced a 15 percent increase in the total number of people dropped for failing to file all the necessary forms - nearly 17,000 more people losing coverage from August to April over the same period a year earlier.

That has contributed to a drop in Medicaid enrollment of 6,500 people, to 501,500 people, since the new requirements went into effect last summer through May - a pattern similar to that of many other states when officials have expected increases in enrollment instead.

State and local health officials say that many of those who lost coverage failed to meet the new documentation requirements. A "high percentage" of those are probably citizens, said Charles E. Lehman, executive director of Office of Operations, Eligibility and Pharmacy at the state's Department of Health and Mental Hygiene.

Eventually, officials hope, many of those people will find their way back onto the Medicaid rolls, but it can take time to get documents in order.

Immigrant advocates say that all these difficulties are arising from legislation that wasn't necessary.

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