Washington State Challenges New Medicaid Rules

Washington state on Monday sued HHS in U.S. District Court over federal regulation that permanently would require states to withhold Medicaid coverage for newborns until proof of citizenship is processed and approved, the AP/Seattle Times reports (Ammons, AP/Seattle Times, 3/6).

The regulation, which took effect in July, requires parents to file applications to obtain Medicaid coverage for their infants and provide documentation proving citizenship for their 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 former policy, passed in 1984, 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 required states to cover the child under Medicaid for one year after the date of birth (California Healthline, 11/3/06).

Many U.S. states have avoided implementation of the regulation, but Washington is the first to challenge its validity in court (Ward, Yakima Herald-Republic, 3/6).

Washington Gov. Christine Gregoire (D) said the policy discriminates against infants born to low-income undocumented immigrants (AP/Seattle Times, 3/6). According to Gregoire, the regulation is illogical because the state already pays the costs of delivering the newborn and, by doing so, validates citizenship.

She added that the U.S. Constitution is clear that a person born in the U.S. automatically is a citizen. Gregoire said the Medicaid application and approval process will delay care for newborns. In addition, many immigrant parents might avoid applying for Medicaid and instead seek care through EDs (McGann, Seattle Post-Intelligencer, 3/6).

Gregoire said, "It's a bureaucratic morass, legally wrong, and I absolutely believe from a moral perspective, it's wrong, fundamentally wrong." She added that the state will request that the court block the regulation in Washington until the issue is addressed in court. She said she does not expect sanctions against the state because it issued the suit (AP/Seattle Times, 3/6).

CMS spokesperson Jeff Nelligan in an e-mail to the Associated Press wrote, "The guidelines for citizenship documentation were developed with extensive input from the states, experts and an advisory group sponsored by the National Association of State Medicaid Directors and mirror those already being used by other federal agencies" (Yakima Herald-Republic, 3/6). He added that they "also reflect methods being used [by] states such as New York, Montana and New Hampshire. The guidance will ensure that the states have maximum help in carrying out their objectives for our Medicaid recipients with the least possible burden on beneficiaries" (AP/Seattle Times, 3/6).

Meanwhile, Sen. Chuck Grassley (R-Iowa) has introduced legislation (S 751) he said would "fix glitches" in the existing law regarding Medicaid eligibility for newborns. He said that provisions of the law, which were meant to prevent ineligible adults from obtaining Medicaid coverage, "erroneously inhibited" access to Medicaid for some newborns.

Grassley said that while he supports measures that would require further documentation of Medicaid applicants' citizenship, such efforts are unnecessary for newborns.

Other legislation (HR 1238) introduced by Rep. Gene Green (D-Texas) would require states to provide one year of Medicaid eligibility to infants whose births were covered by Medicaid (Carey, CQ HealthBeat, 3/5).