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Medicaid News
States Scramble to Follow Medicaid ID Law by July 1
46 million poor on Medicaid
must
produce citizenship documents
By Daniel C. Vock,
Stateline.org Staff Writer
 June 20, 2006 - Health officials in many states
warn that a federal law requiring Medicaid recipients to prove
citizenship starting July 1 could lead to long lines, dropped coverage
and general confusion for the program's participants.
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Medicaid News |
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At least 46 million poor people on Medicaid for the
first time will need to produce documents showing they were born in the
United States or are here legally, the result of a budget-cutting
measure signed by President Bush in February. The law targets illegal
immigrants (who aren’t eligible for Medicaid), but administrators say it
also will hurt American citizens.
Four states – Georgia, Montana, New Hampshire and
New York – already require Medicaid applicants to prove their
citizenship with documents.
The rest rely on sworn statements from Medicaid
enrollees. But after this month, that won’t be enough. Recipients in all
states will have to show a birth certificate, passport or other
citizenship documents to receive health coverage.
That creates problems for Americans without birth
certificates or those who can’t easily find them. And it also means
headaches for people who have their documents; they’ll have to bring
their papers to social service agencies instead of mailing in
applications or filling them out online.
Two Georgia congressmen, Reps. Charlie Norwood (R)
and Nathan Deal (R), led the effort to impose the restrictions.
Norwood spokesman John Stone said the measure would
ensure that illegal immigrants were not receiving taxpayer-financed
medical benefits while Medicaid struggled to cover U.S. citizens. He
said the issue hit home for Norwood, a former dentist, when Georgia
began considering Medicaid cuts.
“Because of the increased pressure illegal aliens
were putting on our Medicaid system, we were looking at eliminating all
childhood dental benefits to our children. I mean this is devastating:
Taking away the health care benefits of the poorest people of our state
and giving them to illegal immigrants, now that’s wrong,” Stone said.
He said the change would save the country at least
$735 million over the next decade, pointing to what he called a
conservative estimate by the Congressional Budget Office.
State officials are scrambling to implement the new
rules, because the Department of Health and Human Services told states
only three weeks before the changes kick in what documents are
acceptable as proof of citizenship.
“Obviously, we are concerned with our ability to be
fully in compliance with this,” said Kathryn Falls, a deputy secretary
for the New Mexico Human Services Department. “We’re concerned about the
impact that it has on our clients. But we are going to do everything we
can.”
Elaine Ryan, the deputy executive director of the
American Public Human Services Association, a group of government-run
social service agencies, called the transition “an impossible task.”
“If people believe this provision will unearth
widespread Medicaid fraud, they’ll be disappointed,” she said. Instead,
Ryan predicted, few cases of fraud would be found, but people who
normally would be eligible for Medicaid will have to wait for their
health insurance.
She said people who are dropped from Medicaid would
likely seek treatment in emergency rooms, which she called a
“perversity” because emergency treatment costs more and Medicaid foots
part of that bill too.
Sandra Shewry, director of the California
Department of Health Services, said state officials there had little
time to digest the new rules, create new procedures and then train
county workers who enroll Medicaid applicants.
“We’re probably in the exact same position as all
other states, which is, the federal law goes into effect, we’re going to
implement it,” she said.
States could have a lot at stake in meeting the
deadline. While penalties for not complying aren’t spelled out, the law
ties states' compliance with their receipt of federal matching funds.
Medicaid is a joint state-federal project that cost
$330 billion in 2005. The federal government provided roughly 57 percent
of that.
A letter from the Centers for Medicare and Medicaid
Services (CMS) told state Medicaid directors that CMS would audit states
to see how well they document citizenship.
The letter classifies different types of
documentation from most reliable to least reliable. “CMS will monitor
the extent to which the state is using primary evidence to establish
both citizenship and identity and will require corrective action to
ensure the most reliable evidence is routinely being obtained,” the
letter said.
To prepare for the law, states are revamping their
applications, retooling their computer systems, informing state workers
and local agencies about the changes, and figuring out how to explain
things to people on Medicaid.
For example, Louisiana officials are drafting two
lists of acceptable documentation: one for people born in the United
States, and one for people born abroad. “We’re trying to keep it simple
and not give people more information than they need,” said Ruth Kennedy,
a deputy Medicaid director for Louisiana.
The impact of the new law will not be as sudden as this January’s
implementation of the new Medicare prescription drug benefit. The
overnight move of 6 million poor seniors from Medicaid prescription drug
coverage to Medicare went roughly, and most states used stopgap measures
to prevent people from going without their medicine.
People already in Medicaid will have to show their
documentation sometime over the next year as part of their regular
renewal, not all at once. And new applicants can still be enrolled while
they make “good faith” efforts to obtain the needed papers.
“There’s nobody in a hospital or nursing home
receiving treatment that’s going to be thrown out. … So it won’t be one
fell swoop, on July 1 everything changes,” said Stone, Norwood’s
spokesman.
Several state administrators who talked to
Stateline.org said they were looking for ways to efficiently use
existing electronic records to confirm people’s citizenship, but they
have questions about whether those efforts would be allowed.
Many states want more details from the federal
government about the rules.
For example, only citizens can receive Social
Security benefits. But states don’t know whether the federal government
will let them assume that people who are receiving Social Security
checks are citizens.
Many states have online access to their own vital
records, such as birth certificates, but getting records for
out-of-state-births can be more difficult.
In some cases, states know exactly when and where a
Medicaid recipient was born, because Medicaid paid for the delivery.
But the APHSA’s Ryan said federal officials told a
gathering of state Medicaid directors in early June that Medicaid’s own
birth records wouldn’t be enough to establish citizenship. (A
spokeswoman for the Department of Health and Human Services said the
agency hasn’t decided that question.)
A study of New York’s Medicaid system, which
already requires documentation, indicated that most Medicaid recipients
were able to produce proof of citizenship without much problem.
However, the study, conducted for the Kaiser
Commission on Medicaid and the Uninsured, found that New York’s rules
are looser than the federal regulations, so Medicaid enrollees there may
have to prove their citizenship again after July 1.
There are many reasons people may not have birth
certificates. Many older Americans were born in farmhouses or on Indian
reservations, not in hospitals. In the days of segregation, blacks in
the South were often denied admittance to hospitals for childbirth.
And even those born in hospitals could have
incomplete records. For example, one New York caseworker told the Kaiser
researchers that Orthodox Jewish boys often leave the hospital without a
first name, because they don’t receive their given name until
circumcision. That means their birth certificates read “Baby Boy” and
the child’s last name.
But not all states are expecting major changes in
July.
Georgia just started checking citizenship documents
in January. “We’ve not heard of any significant problems of any
individuals not being able to produce documents,” said Julie Kerlin, a
spokeswoman for the Georgia Department of Community Health.
Montana has required documentation of citizenship
for more than 20 years. Still, because of the new law, Montana no longer
will consider religious records of such events as baptisms to support
citizenship claims, said Linda Snedigar, the state’s Medicaid policy
supervisor.
“We’re just glad we’ve been doing it all along,”
she said
> Original story at Stateline.org –
click here.
Stateline.org is an
independent element of the Pew Research Center and is based in
Washington, DC. In addition to our online news gathering activities, it
periodically publishes printed reference materials that are free for the
asking, including a State of the States report released every January.
They also sponsor professional development conferences and workshops for
the news media, including the annual conference of CapitolBeat, the
Association of Capitol Reporters and Editors. For further information,
email
editor@stateline.org or call 202-419-4470.
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