Hi all,
I thought those of you on Medicaid might want to know this information:
The Deficit Reduction Act, which was signed by the President on February 8th, contains a provision that would require all citizens applying for Medicaid or renewing their coverage to produce a passport or birth certificate to prove they are U.S. citizens. There would be no exceptions for any Medicaid applicants or beneficiaries, not even individuals with severe physical or mental impairments such as Alzheimer’s disease.
This new requirement, which a recent study by the Inspector General of the Department of Health and Human Services shows to be unnecessary, would almost certainly create significant enrollment barriers for millions of low-income citizens who meet all Medicaid eligibility requirements. It also would increase Medicaid administrative costs. (For a discussion of these issues, see Leighton Ku and Donna Cohen Ross, “New Medicaid Requirement Is Unnecessary and Could Impede Citizens’ Coverage and Policy Priorities,” revised January 4, 2006.)
This analysis provides estimates of the number of Medicaid beneficiaries in each state who would be required to submit a passport or birth certificate between July 2006 (when the new requirement would take effect) and June 2007, and who would be cut off Medicaid if they are unable to do so.
- Analyses of Census data and Medicaid administrative data indicate that about 49 million native-born U.S. citizens and two million naturalized citizens were enrolled in Medicaid over the course of the year in 2003. (Fewer than 4 million legal immigrants also participated.) Thus, about 49 million people would be required to submit birth certificates or passports or lose their Medicaid coverage. (The two million beneficiaries who are naturalized citizens would be allowed to submit naturalization documents.)
- Once they took effect on July 1, 2006, these new requirements would apply to all applications or redeterminations of eligibility that occurred after that date, without any exceptions even for people who are extremely old or have severe physical or mental impairments, such as Alzheimer’s disease. In the following six to twelve months after July 1, 2006, states would have to check citizenship documents for more than 50 million beneficiaries. This would constitute a significant new administrative burden for state and local agencies.
The New Documentation Requirement Under Section 6037 of the conference agreement on the budget reconciliation bill, states would have to require all current and new Medicaid beneficiaries applying as citizens to provide proof of their citizenship. The primary forms of documentation acceptable would be either a passport or a birth certificate presented in conjunction with proof of identity such as a driver’s license. For people who are naturalized citizens, naturalization papers also would be accepted. (The Secretary of HHS would be permitted to specify other acceptable forms of documentation, but the only forms of documentation the Secretary could allow would be forms of documentation that are issued solely to citizens and for which proof of citizenship must be provided. This essentially means that native-born citizens would have to produce birth certificates or passports.) The documentation requirements would take effect July 1, 2006 and would be required when people apply for benefits or, for current beneficiaries, at recertification. Since certification periods typically are six months, most of this burden will fall between July and December 2006, although some certification periods last 12 months. |
- In 16 states, the number of Medicaid beneficiaries who would be required to submit this new paperwork would exceed one million.
- If as little as two percent of Medicaid beneficiaries cannot readily come up with a birth certificate or passport, one million low-income Americans could lose Medicaid coverage and become uninsured or be delayed in obtaining coverage. The percentage of U.S. citizen beneficiaries who are unable to produce readily a birth certificate or passport may well be much larger than that.
The Medicaid program already has extensive requirements to check the immigration status of non-citizens who apply for Medicaid. Non-citizen applicants must provide documentation of their immigration status, and state officials check computerized federal records to verify that status. The new requirement would apply only to people applying for Medicaid as U.S. citizens.
Most states currently allow citizen applicants to self-attest, under penalty of perjury, that they are citizens. Most states then ask for proof of citizenship if they have any reason to question the applicant’s truthfulness. A comprehensive study issued by the HHS Office of the Inspector General (OIG) last year found no substantial evidence that illegal immigrants were claiming to be citizens and successfully enrolling in Medicaid, and OIG did not recommend requiring all applicants to provide documentation. [1] In the absence of evidence that there is a problem in Medicaid, there is no sound reason to create significant new barriers for citizens and increased administrative costs for states.
The new requirements would be imposed on all citizens who apply for or are already receiving Medicaid. There would be no exceptions, regardless of an individual’s physical or mental condition. People currently enrolled in Medicaid would lose coverage if they could not provide such documents when they were recertified.
Large numbers of eligible people could lose coverage because they do not have a birth certificate or passport available at the time they apply or reapply for Medicaid. Low-income individuals on Medicaid usually do not travel abroad and often lack passports. Birth certificates may have been lost over the years in which people move from one home to another; in some cases, as explained below, individuals may have been born outside a hospital and no birth certificate may have been issued. Those who may be harmed include:
- People who have a sudden emergency and need Medicaid coverage immediately but cannot get these documents quickly (some states take a month or longer to provide a duplicate birth certificate when one is requested);
- Those who are homeless, mentally ill, or suffering from senility or a disease such as Alzheimer’s, and who may not be able to secure a birth certificate (or even to recall where they were born);
- People who are in nursing homes or are severely disabled, and would have difficulty getting access to their birth certificates; and
- Those affected by disasters like Hurricanes Katrina or Wilma who have lost most of their possessions and records.
Citizens who have already demonstrated their citizenship for other federal programs, such as Supplemental Security Income or Medicare, would still be required to produce documentation for Medicaid or lose coverage.[2]
In some cases, people may have never been issued a birth certificate because they were born at home and their birth was not officially registered. A particular problem exists for a large number of elderly African Americans because they were born in a time when racial discrimination in hospital admissions, especially in the South, as well as poverty, kept their mothers from giving birth at a hospital. One study estimated that about one in five African Americans born in the 1939-40 period lack a birth certificate because of these problems.[3] Thus, this new provision would exacerbate a historical legacy of discrimination and could lead to a large number of elderly African Americans losing access to health care.
