Proof-of-Citizenship Rule Pushes Drop in Medicaid Enrollment
Medicaid programs in seven states have reported declines in enrollment during the past year that they attribute to new federal rules requiring beneficiaries and applicants to provide documentation proving their U.S. citizenship, the New York Times reports.
The Deficit Reduction Act of 2006 includes a provision that most people who seek Medicaid enrollment must provide "satisfactory documentary evidence of citizenship," such as a passport or the combination of a birth certificate and driver's license. Applicants are required to submit original documents or copies that have been certified by the issuing agency, some state officials say.
The law, written by Rep. Nathan Deal (R-Ga.) and the late Rep. Charlie Norwood (R-Ga.), is intended to prevent undocumented immigrants from enrolling in Medicaid. However, it "has instead shut out tens of thousands of United States citizens," the Times reports. Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia have attributed declines in Medicaid enrollment to the new requirements.
In Florida, the number of children enrolled in Medicaid declined by 63,000, to 1.2 million, from July 2006 to January. Florida Department of Children and Families spokesperson Albert Zimmerman said, "Nearly all of these people are American citizens." In Iowa, the number of Medicaid beneficiaries declined by 5,700, to 92,880, during the second half of 2006 after increasing for five years.
Iowa Department of Human Services Director Kevin Concannon said, "The largest adverse effect of this policy has been on people who are American citizens. We have not turned up many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere else in Iowa."
Ohio Department of Job and Family Services spokesperson Jon Allen said that his state's decline in Medicaid enrollment -- down by 39,000 to 1.3 million since September 2006 -- was the largest drop in 10 years.
Wisconsin from August 2006 through February eliminated Medicaid benefits for an average of 868 people per month because of failure to document citizenship or identity, according to state Medicaid Eligibility Director James Jones. During the same period, 1,758 applications on average were denied each month because of failure to document citizenship or identity.
Jones said, "Congress wanted to crack down on illegal immigrants who got Medicaid benefits by pretending to be U.S. citizens. But the law is hurting U.S. citizens, throwing up roadblocks to people who need care, at a time when we in Wisconsin are trying to increase access to health care."
In Kansas, Medicaid enrollment has declined by 20,000, to 245,000, since July 2006. About 75% of Kansas beneficiaries who lost coverage were children.
Kansas Medicaid Director R. Andrew Allison said, "The federal requirement has had a tremendous impact. Many kids have lost coverage or have not been able to obtain coverage."
Megan Ingmire -- a spokesperson for the Kansas Health Policy Authority, which runs the state Medicaid program -- said the new requirements have led to longer waiting times for enrollment and a "huge backlog" of applications.
In Virginia, the number of children enrolled has declined by 13,300, to 373,800, since July 2006.
Cindi Jones, chief deputy director of the Virginia Medicaid program, said, "The federal rule closed the door on our ability to enroll people over the telephone and the Internet, wiping out a full year of progress in covering kids."
Barry Nangle, the state registrar of vital statistics in Utah, said, "The new federal requirement has created a big demand for birth certificates by a group of people who are not exactly well placed to pay our fees."
Birth certificates typically cost between $10 and $30, the Times reports.
CMS spokesperson Jeff Nelligan said that the rule was "intended to ensure that Medicaid beneficiaries are citizens without imposing undue burdens on them."
Nelligan added, "We are not aware of any data that shows there are significant barriers to enrollment. But if states are experiencing difficulties, they should bring them to our attention."
Chris Riley, chief of staff for Deal, said Deal believes that the law "has saved taxpayers money," adding that Deal "will vigorously fight repeal of that provision." Riley added that Deal will try to extend a similar provision to SCHIP. Riley also said that the requirement could be applied flexibly to minimize hardship for citizens (Pear, New York Times, 3/12).