Proof-of-Citizenship Rules Lead to Drop in Medicaid Enrollment
New Medicaid proof-of-citizenship rules have reduced the number of beneficiaries in many states, although most of those dropped from the rolls were eligible for the program but could not provide adequate documentation, according to a Government Accountability Office report released on Monday, CQ HealthBeat reports.
The GAO report also found that the rules -- initially projected to save the federal government $50 million and state governments $40 million in fiscal year 2008 -- "are likely to cost federal taxpayers significantly more than they generate in savings" because of higher administrative costs (Carey, CQ HealthBeat, 7/24).
Under the law, individuals seeking care through Medicaid must show proof of U.S. citizenship, such as a birth certificate, passport or other form of identification. The law's intent is to prevent undocumented immigrants from claiming to be citizens in order to receive benefits provided only to legal U.S. residents (California Healthline, 6/18).
A GAO survey of 44 states showed that 22 states reported a decline in Medicaid enrollment since the rule took effect, while 12 states said enrollment has not changed and 10 did not know whether it decreased or not. According to the survey, a majority of states reporting enrollment drops attributed the declines to the exclusion of eligible beneficiaries.
State responses also indicated that federal officials underestimated the cost of implementing the new rules. GAO said that CMS officials "did not account for the increased administrative expenditures reported by the states, and the agency's estimated savings from ineligible, noncitizens no longer receiving benefits may be less than anticipated" (Freking, AP/San Francisco Chronicle, 7/24).
A separate analysis released on Tuesday by the majority staff of the House Committee on Oversight and Government Reform showed that in six states, for every $100 of federal money spent implementing the new documentation rules, the federal government saved 14 cents. In those six states, $8.3 million was spent to identify eight undocumented immigrants out of a total of 3.6 million Medicaid beneficiaries, for a savings of $11,048.
CMS spokesperson Mark Kahn said the agency has not reviewed the GAO report but is "absolutely committed to assuring access to Medicaid for all American citizens who are otherwise entitled," adding that the agency will help states with any problems implementing the rules (CQ HealthBeat, 7/24).
Former acting CMS Administrator Leslie Norwalk in June said, "These conclusions are largely based on anecdotal statements or vague feelings by some states that all declines in enrollment must be based on the new requirements."
House Oversight Committee Chair Henry Waxman (D-Calif.) said, "States should be able to decide for themselves whether the costs of the current one-size-fits-all documentation policy are in the best interest of their citizens" (AP/San Francisco Chronicle, 7/20).
The abstract of the report is available online. Note: You will need Adobe Acrobat Reader to view the abstract.