Citizenship Proof Required for Medicaid Services

A new federal law will require individuals seeking health care services through Medicaid to show proof of U.S. citizenship -- such as a birth certificate, passport or another form of identification -- beginning on July 1 (Pear, New York Times, 4/16).

The requirement was included in the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year. The provision's intent is to prevent undocumented immigrants from claiming to be citizens in order to receive benefits only provided to legal residents. Under federal law, undocumented immigrants only can receive emergency care through Medicaid (California Healthline, 4/11).

The Congressional Budget Office estimates that the requirement will save the federal government $220 million over five years and $735 million over 10 years. CBO says that by 2015, about 35,000 people -- mostly undocumented immigrants -- will lose coverage because of the new requirement.

However, the Center on Budget and Policy Priorities estimates that three million to five million low-income citizens could lose Medicaid coverage because they do not have birth certificates or passports.

"This provision is misguided and will serve as a barrier to health care for otherwise eligible United States citizens," Washington state Gov. Christine Gregoire (D) said, adding that many older African Americans who never received birth certificates and homeless people without access to documentation could lose coverage.

Anne Winter, health policy adviser to Arizona Gov. Janet Napolitano (D), expressed concern about Native Americans who do not have the necessary documents and patients with mental impairments who might not understand the requirement.

Lynne Fagnani, senior vice president of the National Association of Public Hospitals and Health Systems, said the requirement will result in more uninsured individuals who "still need care but are more likely to wait until their condition becomes severe and more costly to treat."

CMS Administrator Mark McClellan said, "We are working with states to develop a policy to accommodate the needs of special groups of Americans who may not have traditional government-issued birth certificates." According to the Times, federal officials said they might allow the use of other documents that could help prove citizenship (New York Times, 4/16).