Tougher rules on citizenship records curbing Medicaid enrollment

Washington -- At least a handful of states say they are seeing declines in Medicaid enrollment due to identity and citizenship documentation requirements that went into effect July 1, 2006.

The Deficit Reduction Act of 2005 included a provision requiring states to verify the identity and citizenship of people enrolling in Medicaid or applying for a renewal. This can be done using original documents, such as birth certificates, driver's licenses, passports and other government-issued identification.

The measure was intended to curtail Medicaid fraud by undocumented immigrants. Previously, Medicaid applicants in most states could attest to their citizenship on their applications, under penalty of perjury.

Congress has exempted from the requirements children in state foster care systems and people who receive supplemental security income or Social Security disability insurance.

No one has released a nationwide analysis of the law's effects, but a January report found that Iowa, Louisiana, New Hampshire, Virginia and Wisconsin are having some difficulty maintaining Medicaid enrollment or processing applications because of the act's requirements. The report was co-authored by the Center on Budget and Policy Priorities and the Kaiser Family Foundation's Commission on Medicaid and the Uninsured.

The declines raise concerns that Medicaid-eligible citizens will remain part of the 46.6 million uninsured people in America, the report said.

Some state Medicaid officials say the new requirements have virtually ended their ability to enroll people via the Internet and by mail, thus harming U.S. citizens' ability to get Medicaid coverage, according to one of the report's co-authors, Donna Cohen Ross, director of outreach for the Center on Budget and Policy Priorities. The center analyzes state and federal budgets and programs affecting low-income Americans.

Virginia's Medicaid enrollment decreased from 387,074 on July 1, 2006, to 375,872 on Jan. 1, 2007.

That decline followed two years of steady growth. Enrollment was 345,692 on July 1, 2004, and 375,046 on July 1, 2005, said Cindi Jones, chief deputy director of Virginia's Dept. of Medical Assistance Services.

"An entire year's growth has been wiped out," she said.

The Deficit Reduction Act, not a drop in the number of eligible families, is to blame, Jones said. She pointed out that the Virginia State Children's Health Insurance Program -- which, like other SCHIPs, is not subject to the documentation rules -- saw its enrollment increase from 43,084 on July 1, 2006, to 46,030 on Jan. 1, 2007.

Jones also disputes the notion that the removal of illegal immigrants from the rolls is responsible for the Medicaid decline. She cites an uptick of 1,068 Medicaid enrollees between Nov. 1, 2006, and Dec. 1, 2006, as evidence that the applicants are U.S. citizens but that it's taking them longer to finish their paperwork.

New Hampshire never had a big problem with illegal immigrants on Medicaid, said Tricia Brooks, president and CEO of New Hampshire Healthy Kids Corp., a nonprofit that handles outreach for the state's Medicaid and SCHIP.

But New Hampshire still lost 1,109 Medicaid enrollees between the end of June 2006 and the end of November 2006, Brooks said. November enrollment was 62,651.

A spokesman for the Iowa Dept. of Human Services said the documentation requirements are missing their target. "The names of people who are being dropped from Medicaid are not [Hispanic]," said spokesman Roger Munns.

Iowa's Medicaid enrollment has been erratic. It stood at 383,058 on May 31, 2006, and was 320,346 at year's end.

But Munns said enrollment for the elderly and disabled -- two categories exempt from the documentation requirements -- has been steady, while other populations have declined. This leads him to surmise that the new rules are having an effect.