Medicaid Proof-of- Citizenship Rule Worries Health Care Providers
New America Media, News Report, Donal Brown, Posted: Jun 23, 2006
Editor's Note: The Medicaid rule-change will not affect undocumented immigrants, but may delay access to health care for impoverished U.S. citizens. Donal Brown is a writer for New America Media.
SAN FRANCISCO--A new federal law requiring Medicaid recipients to show proof of citizenship has rattled health care providers, who fear that the requirement would curtail health services to the indigent and lead to loss of revenue.
Contrary to some press reports, the "Citizen Verification Requirement" does not strip undocumented immigrants of the health services they can receive under Medicaid, a federal program that helps states pay for health care for the needy. Eligibility rules do not change for non-citizens.
Immigrants without documentation in California are still eligible for limited-scope MediCal services, which include pregnancy services, nursing home care and some breast and cervical cancer services.
What providers fear is that many low-income, elderly and disabled citizens, who have access to full-scope Medicaid services will be unable to provide the necessary proof of citizenship.
Passed by Congress in 2005, the Deficit Reduction Act provides for verification process for citizens to root out undocumented immigrants who may try to obtain the full scope of Medicaid services reserved for qualifying U.S. citizens. The government is asking states to implement the requirement by July 1.
A recent study has cast doubts on the necessity of the requirement, according to Krystal Moreno Lee of the California Primary Care Association. The study, published in the August 2005 American Journal of Public Health found that health costs have not increased because of use of Medicaid by the undocumented.
Under the new verification requirement, citizens must now provide a birth certificate, drivers license or U.S. passport to prove citizenship. Under the old rules an applicant could supply a written statement claiming citizenship, signed under penalty of perjury.
Lee said the new rule establishes virtually insurmountable burdens for patrons of community clinics that serve the poor. She said the elderly, mentally ill and homeless are often incapable of finding their documentation. Many African-Americans in poor sections of the South were not born in hospitals. They may have been delivered by midwives and may never have received birth certificates.
"The requirement is unrealistic and definitely a challenge for us," says Rhonda Litt, executive director of the Louisiana Primary Care Association. Given that Hurricane Katrina destroyed the birth certificates of many New Orleans residents, citizens must try to secure certification by other means. Litt says one possible method is to have a neighbor testify that the applicant has been living in a certain neighborhood and working in the city. But neighbors themselves may not be able to produce a birth certificate, and so are not eligible to fill out an affidavit.
These "undocumented citizens" will not lose their health care -- at least not immediately. According to the National Association of Community Health Centers, the federal government has agreed that current beneficiaries would not lose benefits so long as they were engaging in "a good-faith effort to provide documentation to the state."
Some community health leaders, however, worry that confusion over the verification process among citizens with and without the proper documents could bring about a reduction in the numbers seeking treatment in their clinics and loss of matching Medicaid funds. They say their mission is to serve everyone who needs care and are determined not to turn anyone away. But when clinics treat more clients ineligible for Medicaid, says Carol Patterson, head of the Marin Community Clinic near San Francisco, their budgets get stretched and inevitably some vital services must be cut.
Litt says discussions about implementing the federal requirement are just starting in Louisiana.
Some community health leaders in California were under the impression that the new requirement would not be implemented in California by July 1, the federally mandated deadline. They were concerned that matching funds from Medicaid would then be suspended and perhaps lost. Lea Brooks, a spokesperson for the California Department of Health and Human Services, says that the department is planning to implement the new policy by July 1.
In an e-mail, Brooks said that there has been a delay in part because the federal government has not yet released an outreach plan as required by law.
"The California Department of Health Service works aggressively to prevent undocumented immigrants from falsely declaring citizenship in order to receive full-scope Medi-Cal benefits," Brooks wrote.
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