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Citizenship mandate for Medicaid is condemned

by Michael Johns, Project Manager | June 07, 2006
Francisco Rivera, trauma tech,
at UCSD Medical Center
attending to a broken foot.
As reported in the The San Diego Union-Tribune on June 6 by Cheryl Clark, Staff Writer.

A move by federal officials to require Medicaid patients to prove they are U.S. citizens would have disastrous consequences for millions of Americans, patient advocates said yesterday.

The Bush administration's new rules are set to take effect July 1. They would affect the nation's estimated 50 million recipients of Medicaid, called Medi-Cal in California. The state has some 6.8 million Medi-Cal patients, who are low-income, elderly or disabled.

Medicaid officials are expected to issue the guidelines for citizenship verification this week. They would likely ask for documents such as passports, birth certificates or naturalization papers. The change is designed to save tax dollars by making it harder for non-citizens, including illegal immigrants, to get government subsidized, non-emergency care at hospitals, clinics, doctors' offices and pharmacies.

The new rules would probably discourage many people, including non-citizens, from applying for Medicaid, patient advocates said. These individuals would likely turn to hospital emergency rooms, where they legally can't be turned away, as a last resort for medical care. That would have a major impact on hospitals, which would have to absorb the additional costs.

"This really won't solve any problem that we know about. But it will require thousands of citizens to provide additional documentation, and we're concerned about that," said Stan Rosenstein, a deputy director for the Department of Health Services in Sacramento.

For some people, there is no birth certificate because the "birth was recorded in the family Bible," Rosenstein said. "And this could affect seniors . . . someone with Alzheimer's in a nursing facility who will need assistance verifying citizenship. And we will need special rules for children."

Children account for about half of Medicaid recipients, while people 65 and older make up roughly 10 percent.

In addition, the homeless and those with serious disabilities who long ago began receiving Medicaid may no longer be able to find their passports, birth certificates or other key documents, said Sherreta Lane of the California Hospital Association in Sacramento.

People "who are absolutely, appropriately legal citizens who just won't have the resources or wherewithal to get their documentation in order will be denied instead," Lane said.

Documentation would be required when a person applies for Medicaid or when eligibility is recertified on or after July 1. Typically, people would have 45 days to prove they're citizens. Disabled individuals would have 90 days.