Federal government seeks to cheat people out of benefits


Richard Moore

Original source URL:

March 12, 2007

Citizens Who Lack Papers Lose Medicaid

WASHINGTON, March 11 ‹ A new federal rule intended to keep illegal immigrants 
from receiving Medicaid has instead shut out tens of thousands of United States 
citizens who have had difficulty complying with requirements to show birth 
certificates and other documents proving their citizenship, state officials say.

Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia have all 
reported declines in enrollment and traced them to the new federal requirement, 
which comes just as state officials around the country are striving to expand 
coverage through Medicaid and other means.

Under a 2006 federal law, the Deficit Reduction Act, most people who say they 
are United States citizens and want Medicaid must provide ³satisfactory 
documentary evidence of citizenship,² which could include a passport or the 
combination of a birth certificate and a driver¹s license.

Some state officials say the Bush administration went beyond the law in some 
ways, for example, by requiring people to submit original documents or copies 
certified by the issuing agency.

³The largest adverse effect of this policy has been on people who are American 
citizens,² said Kevin W. Concannon, director of the Department of Human Services
in Iowa, where the number of Medicaid recipients dropped by 5,700 in the second 
half of 2006, to 92,880, after rising for five years. ³We have not turned up 
many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere
else in Iowa,² Mr. Concannon said.

Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid 
Services, said the new rule was ³intended to ensure that Medicaid beneficiaries 
are citizens without imposing undue burdens on them² or on states. ³We are not 
aware of any data that shows there are significant barriers to enrollment,² he 
said. ³But if states are experiencing difficulties, they should bring them to 
our attention.²

In Florida, the number of children on Medicaid declined by 63,000, to 1.2 
million, from July 2006 to January of this year.

³We¹ve seen an increase in the number of people who don¹t qualify for Medicaid 
because they cannot produce proof of citizenship,² said Albert A. Zimmerman, a 
spokesman for the Florida Department of Children and Families. ³Nearly all of 
these people are American citizens.²

Since Ohio began enforcing the document requirement in September, the number of 
children and parents on Medicaid has declined by 39,000, to 1.3 million, and 
state officials attribute most of the decline to the new requirement. Jon Allen,
a spokesman for the Ohio Department of Job and Family Services, said the state 
had not seen a drop of that magnitude in 10 years.

The numbers alone do not prove that the decline in enrollment was caused by the 
new federal policy. But state officials see a cause-and-effect relationship. 
They say the decline began soon after they started enforcing the new rule. 
Moreover, they say, they have not seen a decline in enrollment among people who 
are exempt from the documentation requirement ‹ for example, people who have 
qualified for Medicare and are also eligible for Medicaid.

Wisconsin keeps detailed records listing reasons for the denial or termination 
of benefits. ³From August 2006 to February of this year, we terminated benefits 
for an average of 868 people a month for failure to document citizenship or 
identity,² said James D. Jones, the eligibility director of the Medicaid program
in Wisconsin. ³More than 600 of those actions were for failure to prove 
identity.² In the same period, Mr. Jones said, the state denied an average of 
1,758 applications a month for failure to document citizenship or identity. In 
1,100 of those cases, applicants did not provide acceptable proof of identity.

³Congress wanted to crack down on illegal immigrants who got Medicaid benefits 
by pretending to be U.S. citizens,² Mr. Jones said. ³But the law is hurting U.S.
citizens, throwing up roadblocks to people who need care, at a time when we in 
Wisconsin are trying to increase access to health care.²

Medicaid officials across the country report that some pregnant women are going 
without prenatal care and some parents are postponing checkups for their 
children while they hunt down birth certificates and other documents.

Rhiannon M. Noth, 28, of Cincinnati applied for Medicaid in early December. When
her 3-year-old son, Landen, had heart surgery on Feb. 22, she said, ³he did not 
have any insurance² because she had been unable to obtain the necessary 
documents. For the same reason, she said, she paid out of pocket for his 
medications, and eye surgery was delayed for her 2-year-old daughter, Adrianna.

The children eventually got Medicaid, but the process took 78 days, rather than 
the 30 specified in Ohio Medicaid rules.

Dr. Martin C. Michaels, a pediatrician in Dalton, Ga., who has been monitoring 
effects of the federal rule, said: ³Georgia now has 100,000 newly uninsured U.S.
citizen children of low-income families. Many of these children have missed 
immunizations and preventive health visits. And they have been admitted to 
hospitals and intensive care units for conditions that normally would have been 
treated in a doctor¹s office.²

Dr. Michaels, who is president of the Georgia chapter of the American Academy of
Pediatrics, said that some children with asthma had lost their Medicaid coverage
and could not afford the medications they had been taking daily to prevent 
wheezing. ³Some of these children had asthma attacks and had to be admitted to 
hospitals,² he said.

In Kansas, R. Andrew Allison, the state Medicaid director, said: ³The federal 
requirement has had a tremendous impact. Many kids have lost coverage or have 
not been able to obtain coverage.² Since the new rule took effect in July, 
enrollment in Kansas has declined by 20,000 people, to 245,000, and 
three-fourths of the people dropped from the rolls were children.

Megan J. Ingmire, a spokeswoman for the Kansas Health Policy Authority, which 
runs the state Medicaid program, said the waiting time for applicants had 
increased because of a ³huge backlog² of applications. ³Applicants need more 
time to collect the necessary documents, and it takes us longer to review the 
applications,² Ms. Ingmire said.

The principal authors of the 2006 law were Representatives Charlie Norwood and 
Nathan Deal, both Georgia Republicans. Mr. Norwood died last month.

Chris Riley, the chief of staff for Mr. Deal, said the new requirement did 
encounter ³some bumps in the road² last year. But, he said, Mr. Deal believes 
that the requirement ³has saved taxpayers money.² The congressman ³will 
vigorously fight repeal of that provision² and will, in fact, try to extend it 
to the Children¹s Health Insurance Program, Mr. Riley said. He added that the 
rule could be applied flexibly so it did not cause hardship for citizens.

In general, Medicaid is available only to United States citizens and certain 
³qualified aliens.² Until 2006, states had some discretion in deciding how to 
verify citizenship. Applicants had to declare in writing, under penalty of 
perjury, whether they were citizens. Most states required documents, like birth 
certificates, only if other evidence suggested that a person was falsely 
claiming to be a United States citizen.

In Virginia, health insurance for children has been a top priority for state 
officials, and the number of children on Medicaid increased steadily for several
years. But since July, the number has declined by 13,300, to 373,800, according 
to Cindi B. Jones, chief deputy director of the Virginia Medicaid program.

³The federal rule closed the door on our ability to enroll people over the 
telephone and the Internet, wiping out a full year of progress in covering 
kids,² Ms. Jones said.

State and local agencies have adopted new procedures to handle and copy valuable
documents. J. Ruth Kennedy, deputy director of the Medicaid program in 
Louisiana, said her agency had received hundreds of original driver¹s licenses 
and passports in the mail.

Barry E. Nangle, the state registrar of vital statistics in Utah, said, ³The new
federal requirement has created a big demand for birth certificates by a group 
of people who are not exactly well placed to pay our fees.² States typically 
charge $10 to $30 for a certificate.

Copyright 2007 The New York Times Company

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