Debate Over Health Care Coverage Turns on Citizenship

Proving U.S. citizenship is becoming an ever-more important issue as states comply with rules that require verification of citizenship as part of the Medicaid application process. And in the case of the California Family Planning, Access, Care and Treatment program, the push to enforce federal eligibility rules has state officials up in arms.

Family PACT -- funded with state and federal money -- provides birth control to women at no cost, and current rules do not limit the program to beneficiaries of Medi-Cal, California's Medicaid program. But officials in Washington, D.C., are pushing for that policy to be changed and are holding off on final approval of a funding agreement for Family PACT until the issue is resolved.

So why are California officials so reluctant to limit the program to Medi-Cal beneficiaries? For starters, they say verifying citizenship and enrolling people in Medi-Cal will drive up costs for the program and cut into $1.4 billion the state says the program saves each year from avoiding unintended pregnancies.

As for citizenship verification for Medicaid in general, California officials might be glad to have put off compliance with the federal rules while the state compared information from different databases to try to minimize the number of people who will need to establish their citizenship to maintain or apply for Medi-Cal coverage. At least seven states that have gone forward with the rules have seen their Medicaid enrollment fall since the rules took effect, and the New York Times reports that many of those shut out of the programs are U.S. citizens.

As this debate continues, California lawmakers have taken action on two bills aimed at expanding children's health coverage -- both of which would eliminate citizenship requirements for Medi-Cal and Healthy Families, California's version of the State Children's Health Insurance Program.