Policy Ends Medicaid Enrollment for Undocumented Infants

Under a new federal policy, infants born in the U.S. to undocumented immigrants will no longer be automatically enrolled in Medicaid, the Bush administration said on Thursday, the New York Times reports. The new policy -- part of the Deficit Reduction Act signed by President Bush in February -- took effect in July, although some states have not begun to enforce it.

The change requires parents to file applications to obtain Medicaid coverage for their infants, and they must provide documentation proving citizenship for the children, who legally are U.S. citizens because they were born in the country. Federal law generally prohibits undocumented immigrants from enrolling in Medicaid, but they can receive Medicaid coverage for emergency care, including labor and delivery.

Under the previous policy, an infant born to a woman who received emergency care under Medicaid for labor and delivery became automatically eligible for coverage as well. That policy, passed in 1984, required states to cover the child under Medicaid for one year from the date of birth.

Acting CMS Administrator Leslie Norwalk on Thursday said that the new policy "reflects what the new law says in terms of eligibility."

The new law, which does not specifically mention newborns, was designed to tighten documentation requirements to prevent undocumented immigrants from claiming U.S. citizenship to obtain Medicaid coverage.

Norwalk said, "When emergency Medicaid pays for a birth, the child is not automatically deemed eligible. But the child could apply and could qualify for Medicaid because of the family's poverty status" (Pear, New York Times, 11/3).

Norwalk said CMS has found no cases in which an infant was denied care because of the new policy (AP/Philadelphia Inquirer, 11/3). She added, "If anyone knows of a child being denied care, we want to know about it. Please step up and tell us."

John Stone, a spokesperson for Rep. Charlie Norwood (R-Ga.) -- one of the main authors of the new law -- said, "With newborns, there should be no problem. All you have to do is provide a birth certificate or hospital records verifying birth."

Some physicians groups have raised concerns that the new policy could prevent infants from receiving necessary care. They note that obtaining a birth certificate can take several weeks in some states, the Times reports (New York Times, 11/3).

The American Academy of Pediatrics, the American Academy of Family Physicians and the March of Dimes recently sent a letter to CMS officials expressing concerns that the new policy would delay or deny access to care for newborns and would lead to higher health care costs in the long term. "Preventative care saves money for states that provide Medicaid coverage and the federal government that helps pay for it," the groups wrote, adding, "Some infants require immediate post-delivery care for conditions or illnesses detected immediately after birth."

The groups said some physicians could be reluctant to provide care for infants without coverage because of cost concerns. The letter identified Georgia, Kentucky, Tennessee and Virginia as states that have denied care to infants born to undocumented immigrants, although it did not cite specific instances (Freking, AP/Philadelphia Inquirer, 11/3).

AAP President Jay Berkelhamer said the new policy "punishes babies who, according to the Constitution, are citizens because they were born here." He added that the policy "will cost the health care system more in the long run" because the children could go without immunizations, preventive care and other treatments that are necessary in the first year of life. In addition, undocumented immigrants whose children are legally eligible for Medicaid might be reluctant to apply because of concerns over "the threat of deportation," he said.

Sara Rosenbaum, a professor of health law at George Washington University, said, "The new policy reflects a tortured reading of the new law and is contrary to the language of the 1984 statute, which Congress did not change. The whole purpose of the earlier law, passed with bipartisan support, was to make sure that a baby would not have a single day's break in coverage from the date of birth through the first year of life."

California has objected to the new policy, the Times reports.

Kim Belshé, secretary of the state Health and Human Services Agency, said, "By virtue of being born in the United States, a child is a U.S. citizen. What more proof does the federal government need?"

Marilyn Wilson, a spokesperson for the Tennessee Medicaid program, said, "The federal government told us we have no latitude. All states must change their policies and practices." She added, "We will not be able to cover any services for the newborn until a Medicaid application is filed. That could be days, weeks or months after the child is born" (New York Times, 11/3).

In Virginia, the total number of children enrolled in the state Medicaid program has declined by 12,000 since the new documentation policies took effect in July -- the sharpest enrollment decrease ever in the state, according to the Richmond Times-Dispatch.

Steve Ford, director of policy at the Virginia Department of Medical Assistance Services, said the state likely will soften the policy to allow Medicaid coverage for newborns if the mother applies for coverage at the hospital at the time of birth.

The state Department of Health would then have 15 days to verify the birth records, he said (McKelway, Richmond Times-Dispatch, 11/3).

Texas has a long-standing policy similar to the new federal policy, the Houston Chronicle reports (Carroll/Markley, Houston Chronicle, 11/3).