Government

Medicaid citizenship rules costing health centers

Facilities are losing Medicaid patients and their funding, a survey finds.

By Doug Trapp — Posted June 18, 2007

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Medicaid documentation requirements are straining federally qualified health centers by decreasing their Medicaid populations -- their largest source of funding.

Medicaid identity and citizenship requirements that began July 1, 2006, have cost health centers $28 million to $85 million and 2.2% to 6.7% of their 4.8 million Medicaid enrollees, found an online survey released last month by the George Washington University School of Public Health and Health Services. Responses came in from 139 of the 300 federally qualified health centers surveyed. There are 952 such facilities in the U.S.

The report is the first attempt to examine the national effects of the rules, which require Medicaid applicants to prove their citizenship using original documents -- birth certificates, driver's licenses, passports and other government-issued identification -- or certified copies.

Critics have said the rules, in an attempt to keep undocumented immigrants off Medicaid, place an unreasonable burden on the elderly, foster children and the physically or mentally disabled because they have difficulty accessing such documents. Previously, applicants in most states were able to attest to their citizenship under penalty of perjury.

"We think these findings underscore the need to fundamentally rethink both the statute and the regulations," said Sara Rosenbaum, one of the report's authors and professor and chair of the George Washington University Dept. of Health Policy.

Almost half of health centers reported an operating deficit in 2005, said Dan Hawkins, vice president for federal, state and public affairs for the National Assn. of Community Health Centers. Medicaid funds accounted for 37% of centers' 2005 revenues, the report said.

The authors called their Medicaid loss estimates conservative because they don't count newborns affected by the regulation. They also assume that people who can't prove citizenship would be locked out of Medicaid for only six months. But centers are reporting that some people are permanently losing coverage, Hawkins said.

"These losses threaten to make a bad situation worse," he said. The predicted lost revenue represents enough to pay the salaries of 27 to 83 physicians, among other staff, and care for 55,000 to 166,000 uninsured patients, the report stated.

Helping hand for some

The resources available to help people deal with the rules vary by state. For example, Texas Medicaid applicants can get assistance from outreach workers at some health centers, but Ohio applicants have very limited help, at best.

The five Centro Med health centers in San Antonio screen 1,000 patients a month for public programs. About one-third of those applicants are Medicaid eligible, and a handful have been kept off the program by the rules, said Ana Maria Garza Cortez, director of development.

Two of the Centro Med centers have an on-site state Medicaid worker who helps Medicaid applicants by using the state's electronic birth certificate database. There are only 32 state Medicaid workers at Texas health centers, noted Jana Blasi, deputy director for the Texas Assn. of Community Health Centers.

By contrast, Ohio doesn't have a birth certificate database and, at best, has several county workers at health centers working less than a day a week, said Julie DeRossi, director of state government affairs for the Ohio Assn. of Community Health Centers.

Medicaid applicants at the Family Health Center in Waverly have to travel to their county of birth to retrieve the document because rural Pike County doesn't have a hospital.

"Everyone is scrambling to try to find the information," said Randy Runyon, the center's assistant executive director.

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ADDITIONAL INFORMATION

Medicaid patient load drops

More than 20% of 300 federally qualified health centers responding to a recent survey reported a decrease in Medicaid patients. Among the reasons, by percent of facilities reporting declines:

Federal documentation requirements 66%
State reduced covered benefits 45%
Beneficiaries no longer in the area 34%
More physicians accepting Medicaid 28%
State reduced eligibility 24%
Other state policy that reduced enrollment 41%

Source: George Washington University School of Public Health and Health Services, May

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External links

"An Initial Assessment of the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients," George Washington University School of Public Health and Health Services policy brief, May, in pdf (link)

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