Medicaid Hurdle for Immigrants May Hurt Others
The Deficit Reduction Act (DRA) signed into law by President Bush on February 8 contains a little known surprise for many Medicaid beneficiaries. Under the DRA, more than 50 million Medicaid recipients will soon have to produce birth certificates, passports or other documents to prove that they are United States citizens, and everyone who applies for coverage after June 30 will have to show similar documents.
The requirement is meant to stop the “theft of Medicaid benefits by illegal aliens,” in the words of Representative Charlie Norwood, Republican of Georgia, a principal author of the provision. In enforcing the new requirement, federal and state officials must take in account passions stirred by the recent debate over immigration policy. State officials worry that many people will be unable to come up with the documents needed to prove citizenship. In addition, hospital executives said they were concerned that the law could increase their costs by reducing the number of patients with insurance.
The new requirement takes effect on July 1. The Congressional Budget Office estimates that it will save the federal government $220 million over five years and $735 million over 10 years. Estimates of the number of people who will be affected vary widely. The budget office expects that 35,000 people will lose coverage by 2015. Most of them will be illegal immigrants, but some will be citizens unable to produce the necessary documents. Some Medicaid experts put the numbers much higher, saying that millions of citizens could find their health benefits in jeopardy.
State officials are trying to figure out how to comply. Many said the requirement would result in denying benefits to some people who were entitled to Medicaid but could not find the necessary documents. “This provision is misguided and will serve as a barrier to health care for otherwise eligible United States citizens,” said Gov. Chris Gregoire of Washington, a Democrat. She said “the provision would cause hardship for many older African-Americans who never received birth certificates and for homeless people who did not have ready access to family records.”
Hospitals and nursing homes also are expressing concern. “The new requirement will result in fewer people being eligible for Medicaid or enrolling in the program, and that means more uninsured people,” said Lynne P. Fagnani, senior vice president of the National Association of Public Hospitals and Health Systems. “They still need care, but are more likely to wait until their condition becomes more severe and more costly to treat.”
Under the DRA, states cannot receive federal Medicaid money unless they verify citizenship by checking documents like passports and birth certificates for people who receive or apply for Medicaid. In a draft letter providing guidance to state officials, the Bush administration says, “An applicant or recipient who does not cooperate with the requirement to present documentary evidence of citizenship may be denied eligibility or terminated” from Medicaid.
The concern is that many older Americans do not have birth certificates because their parents did not have access to hospitals, and so they were born at home. In New Jersey, Ann Clemency Kohler, the Medicaid director, said: “There are lots of reasons why people born here may not have copies of their birth certificates. And many people in their 80’s and 90’s just don’t have a driver’s license or a passport because they’re not driving or traveling overseas.”
In general, Medicaid is available only to United States citizens and certain “qualified aliens.” Legal immigrants are, in many cases, barred from Medicaid for five years after they enter the United States. Under a 1986 law, applicants for Medicaid have to declare in writing, under penalty of perjury, whether they are citizens and, if not, whether they are “in a satisfactory immigration status.” State Medicaid officials were already required to check the immigration status of people who said they were noncitizens. But until this year, when applicants claimed United States citizenship, states had discretion: they could choose whether to require documentation.
The law specifies documents that can be used to establish citizenship. A United States passport by itself is enough. Or a person can use “a certificate of birth in the United States,” together with a document that confirms identity, like a driver’s license with a photograph.
Source: New York Times, April 16, 2006