May 14, 07

NEWS / New law is causing problems for legal U.S. residents trying to obtain Medicaid, study shows

A controversial law that took effect last year requiring low-income U.S. citizens to prove their citizenship in order to obtain or renew Medicaid benefits is causing havoc among some individuals who are legally entitled to receive the government insurance, according to a study.
The first analysis of the impact of the citizenship documentation rule, signed into law by President Bush and which took effect July 1, involved randomly surveying 300 federally funded health centers around the country about Medicaid enrollment and citizenship proof.

The researchers at George Washington University in Washington, D.C., found that 90 percent of the health centers reported Medicaid enrollment difficulties for patients of all ages because of the citizenship documentation rule. The research was conducted by the university’s School of Public Health and Health Services and the findings were released last week.

More than 43 percent of the health centers said their patients faced a longer enrollment time, lacked the proper documentation to prove citizenship or had to pay to obtain the required documents, the researchers found.

The consequence is that nearly half of them saw a disruption in their ability to get specialty medical care.

Apart from the university research, the Florida Department of Children and Families reports that an average of 400 Medicaid applicants are being denied every month because of the inability to prove citizenship, said Al Zimmerman, DCF spokesman in Tallahassee.

What has not been tracked is how many of the denied applicants return with the citizenship proof and become eligible, he said. The belief is that the bulk are U.S. citizens.

“Nearly all of the people denied are citizens who are unable to come up with a birth certificate or passport,” he said.

From another perspective, the researchers found that the health centers had to beef up staff time to help existing Medicaid patients get re-certified for coverage and to help new patients navigate the more complex Medicaid enrollment system now that proof of citizenship is required.

Proof involves presenting original or copies of a birth certificate, passport, certificate of citizenship or naturalization.

Federal law has always required that Medicaid beneficiaries be U.S. citizens but 47 states allowed individuals to attest to their citizenship in writing. The new citizen documentation rule was put forth to preserve Medicaid budgets, a mix of federal and state dollars, to low-income U.S. citizens and to halt cuts to services.

Several patient advocacy organizations, hospitals and health clinics countered that few illegal aliens were fraudulently claiming citizenship to get Medicaid benefits before the documentation requirement, whether out of fear of deportation or because they knew they can go to a hospital emergency room and get treated regardless of citizenship status. A separate federal law sets forth that emergency rooms must treat and stabilize anyone regardless of ability to pay.

The researchers estimate that the immediate impact of the documentation requirement is it will eliminate Medicaid coverage for as much as 6.7 percent of pediatric and adult Medicaid eligible patients. That translates into as many as 319,500 legal citizens.

Southwest Florida health centers are experiencing different outcomes as a result of the citizen proof rule.

Collier Health Services Inc., CHSI, in Collier County has seen declines in its Medicaid population for both adults and children. On the other hand, Family Health Centers in Lee, Charlotte and western Hendry counties has not.

“Our numbers of patients in total between 2005 and 2006 was pretty flat, it went up a fraction, but our Medicaid percentage for children under (the age of) 19 decreased by 2 percent and for Medicaid adults it decreased by 11 percent,” said Steve Weinman, vice president of CHSI, which has 11 programs and clinics predominantly serving the poor. “Eleven percent is a lot.”

Number-wise, the number of adult Medicaid patients dropped from 1,423 individuals in 2005 to 1,273 individuals in 2006, he said.

“This is a group of people who are not good at managing paperwork, you have to keep in mind,” Weinman said, adding that CHSI has put considerable effort in staff time to help patients who qualify for Medicaid to get enrolled. “(Enrollment) went down this amount even with all the work we did.”

Weinman can’t say absolutely that the citizenship proof rule is to blame but he suspects it is the cause.

“The same thing is being reported all over,” he said. “I’ve heard this from around the state at health centers.”

He questions why the citizenship proof law was enacted at all because few illegal aliens were fraudulently attempting to get Medicaid coverage in the first place.

“The number of illegal people managing to get on Medicaid is pretty minuscule,” he said. “That just wasn’t happening.”

The Family Health Centers, on the other hand, is seeing an increase in its Medicaid population against its total patient base, which went from 31 percent in 2005 to 32 percent last year said Bob Johns, spokesman for the nonprofit organization.

Based on the statistics, the citizenship proof rule appears not to be an issue, he said.

“It may be an anomaly for us,” he said.

The increase in the Medicaid population is a function of population growth, a high concentration of uninsured patients and a concerted effort on their part to increase its pediatric program, he said. Children born in the U.S. are citizens and would be issued birth certificates and so their wouldn’t be an issue with proof, he said.

Hospitals in the region report that the new rule is not causing hardships to the extent anticipated.

There have been cases where Medicaid applicants are being denied coverage for lack of the citizenship proof or other documentation but the Lee Memorial Health System isn’t tracking the citizenship proof issue separately, said Billie Jo DeBolt, director for business services.

“We have had an impact,” she said. “As of yet it has not been as significant as I first thought it would be. That may be just a matter of time.”

The reason for that is many Medicaid beneficiaries haven’t faced recertification yet, so they haven’t been subject yet to the documentation requirement, she said.

“I don’t think we have seen the full impact yet,” DeBolt said.

The NCH Healthcare System in Collier likewise has not seen the problems that they expected, said Debbie Curry, NCH spokeswoman.

“The change requiring patients to prove their citizenship in order to qualify for Medicaid has apparently caused some delays but not to the extent originally anticipated,” she said.

By Liz Freeman


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