While the new documentation requirements under the Deficit Reduction Act (DRA) (PubLNo 109-171) will prohibit illegal aliens from obtaining Medicaid, and save taxpayer dollars, it will also disrupt health care delivery for those who come to the U.S. expecting free health care, according to witnesses who testified at a House Committee on Energy and Commerce during a hearing in Dalton, Ga., on August 15, 2006.
Jim Gardner, CEO of Northeast Georgia Health System, Inc., Gainesville, Ga., said the DRA no longer allows for self-declaration of citizenship, but requires verification. “This means that every Medicaid recipient must prove citizenship to be eligible for Medicaid benefits, but not to be eligible to receive emergency medical services,” he said.
Proof of citizenship. Gardner told the story of a woman who recently came from U.S. from Mexico in order to receive dialysis treatments. After receiving thousands of dollars in emergency care, she was stabilized and sent back to her home. “It will take years until word spreads that proof of citizenship will be required to receive benefits intended for U.S. citizens,” he said. “Years of failing to require proof of citizenship has meant that illegal immigrants could come to the U.S. and receive free care, paid for through tax dollars,” he said.
American citizenship or legal immigration status have been a requirement for Medicaid eligibility; however, many states allowed applicants to assert their citizenship status by merely checking a box on a form, said Jean Sheil, director of the director of the Family and Children's Health Program at CMS' Center for Medicaid and State Operations. The DRA now holds states financially responsible for Medicaid expenditures for individuals claiming to be citizens unless the individuals provide actual documentary evidence supporting their citizenship and identity, she noted. This new requirement applies to new applications for Medicaid eligibility and re-determinations beginning July 1, 2006.
Coverage for newborns. The American Academy of Pediatricians (AAP) recommended CMS confirm with states that newborns are presumed eligible for Medicaid coverage. “Paperwork should not delay payment for services provided to resident newborns,” said Marty Michaels on behalf of the academy.
The AAP also recommended the following:
Georgia State Representative Chip Rogers (R) said in written testimony that only four states—Montana, New York, New Hampshire, and Georgia—have been requiring proof of citizenship to receive Medicaid benefits. Most states have not been verifying lawful status “prior to giving away the taxpayers money,” he said. The DRA “will remove the misguided policy of deducting indigent care expenses for illegal aliens from the states Medicaid funds,” he said.
"Devastating impact." Meanwhile, 49 House Democrats wrote to CMS on August 11, 2006, saying that the new requirements have a “devastating impact” on the health coverage of millions of Medicaid beneficiaries and applicants. They urged CMS to allow states to provide coverage to eligible citizens based on their sworn declaration of citizenship and to allow them a “reasonable opportunity” to provide the necessary documents.
They also asked for flexibility for states to use alternative methods to verify citizenship or identify “special circumstances” when the state finds that compliance with the regulations would be a hardship and the state has reasonable grounds to conclude that the individual is a citizen.
SOURCE: CCH Washington Bureau, August 17, 2006.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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