Medicaid and citizenship proof

by rcentor on March 16, 2006

Yesterday I lobbied on Capital Hill for SGIM. We discussed several issues, but one really struck me as a key issue worth blogging. I hope this rant will encourage other medical bloggers to make this issue a cause celebre.

NEW REQUIREMENT FOR BIRTH CERTIFICATES OR PASSPORTS COULD THREATEN MEDICAID COVERAGE FOR VULNERABLE BENEFICIARIES:A STATE-BY-STATE ANALYSIS

This is an interesting issue. Part of the Deficit Reduction Act stipulates that Medicaid beneficiaries must “prove” citizenship. Proof of citizenship requires either a valid passport or a birth certificate. Now while this standard seems rather easy and straightforward for most of us, consider the average Medicaid recipient. Few have passports. Many have no easy access to their birth certificates.

Several analyses show that few illegal aliens receive Medicaid. So this requirement likely only attacks citizens.

Large numbers of eligible people could lose coverage because they do not have a birth certificate or passport available at the time they apply or reapply for Medicaid. Low-income individuals on Medicaid usually do not travel abroad and often lack passports. Birth certificates may have been lost over the years in which people move from one home to another; in some cases, as explained below, individuals may have been born outside a hospital and no birth certificate may have been issued. Those who may be harmed include:

* People who have a sudden emergency and need Medicaid coverage immediately but cannot get these documents quickly (some states take a month or longer to provide a duplicate birth certificate when one is requested);

* Those who are homeless, mentally ill, or suffering from senility or a disease such as Alzheimer’s, and who may not be able to secure a birth certificate (or even to recall where they were born);

* People who are in nursing homes or are severely disabled, and would have difficulty getting access to their birth certificates; and

* Those affected by disasters like Hurricanes Katrina or Wilma who have lost most of their possessions and records.

Citizens who have already demonstrated their citizenship for other federal programs, such as Supplemental Security Income or Medicare, would still be required to produce documentation for Medicaid or lose coverage.[2]

In some cases, people may have never been issued a birth certificate because they were born at home and their birth was not officially registered. A particular problem exists for a large number of elderly African Americans because they were born in a time when racial discrimination in hospital admissions, especially in the South, as well as poverty, kept their mothers from giving birth at a hospital. One study estimated that about one in five African Americans born in the 1939-40 period lack a birth certificate because of these problems.[3] Thus, this new provision would exacerbate a historical legacy of discrimination and could lead to a large number of elderly African Americans losing access to health care.

The costs of applying this new requirement likely exceed any potential savings. But regardless, this requirement seems prejudicial. It does not pass the smell test.

I will continue to make this a major cause for the near future. I hope I can recruit other medical bloggers to call for an appeal of this onerous requirement.

Thanks in advance for your support.

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{ 15 comments… read them below or add one }

Tara March 16, 2006 at 9:17 am

First off, I love your blog. That said I have to disagree with what you said about few illegal Aliens using Medicaid. Go to your local county hospital or Human Services Dept and almost every person there is pregnant and on medicaid and illegal. I was at Parkland Hospital not too long ago and diagnosed with Uterine Cancer. I went to the Medicaid office there and they told me they only gave it to women who were pregnant. All the people in there save maybe 1 or 2 were illegals that couldnt speak a lick of english and had 3-5 children at her feet. I, being born and raised in the US could not get Medicaid for cancer treatment, but because they were pregnant they could. Sorry about the rant, still adore the blog

jerry March 16, 2006 at 10:57 am

Medicaid should go to US citizens only. I would rather treat these people for free in the ER and send them a bill than to keep the never ending gravy train open from Mexico. All they have to do is get pregnant, that gets them into the system, then pretty soon the whole family is in on it

Marcy March 16, 2006 at 12:19 pm

This is another great example in the absurdities of life.

Let us not make (or ENFORCE!) rules/laws that will correct the real problem, but instead create rules/laws that exclude and punish those who diligently follow the current laws.

Renee March 16, 2006 at 3:18 pm

I recently had to get a copy of my elderly father’s birth certificate; he’s in a nursing home and would have no idea how to do this himself.

These were the steps:
1. Do Google search for ‘Pennsylvania certified birth certificate’.
2. Get to correct Penna government site, download pdf request form, print out.
3. Fill out form. They wanted dad’s vital statistics, as well as his mother’s maiden name, and even the name of the hospital where he was born. Luckily, he still rememberd the hospital name.
4. Send in form, plus $20 check
5. Got certified certificate in mail in 4 weeks.

I can see where this process would be too much for the elderly, mentally impaired, or people with no access to the Internet. And yes, Dad was born in this country. Even though he has a Soc. Sec. card, Medicare card and driver’s license, these were not enough to prove citizenship.

I understand the government’s rationale for requiring proof of citizenship, but the way they are going about it is all wrong. They are essentially requiring the same level of proof that it takes to get a passport.

kitty March 17, 2006 at 12:25 pm

I understand the government’s rational – most of us would rather have our taxes help somebody like Tara than an illegal immigrants.
But I am concerned that denying these people medical care for something like TB would put all our health in danger. So I think, at least exceptions should be made for communicable deseases – like some fund or something.

GruntDoc March 18, 2006 at 1:11 am

From the linked site FOUR MILLION non-citizens are on the medicaid rolls, and you think that’s OK?

I’ve had to produce birth certificates for things (my passport comes to mind) and it wasn’t that big a deal. Legitimately obtaining a passport isn;t really that hard.

And, as the benefits can run to tens of thousands of taxpayer dollars, it’s not that high a bar to set. We aren’t getting DNA samples or fingerprints, we;re just trying to make sure that tax money goes to pay for the health care of citizens only.

It’s not that onerous. Save the outrage and effort for those four million who abuse the system.

GruntDoc March 18, 2006 at 1:45 am

Oops. Mea Culpa. I misread the linked article, which says “fewer than four million legal immigrants also participated…” and I apologize for the error.

That said there’s no evaluation that one person who is a non-citizen is on medicaid, because they haven’t bothered to check. It’s a system that begs to be abused, and given my experience it is being abused.

To be tax supported for your medical care, proof of citizenship isn’t that onerous.

Steve Lucas March 18, 2006 at 8:54 am

What I find troubling is this is another attempt to have everyone in the country carry a government approved ID card. There are plans for state drivers license to all meet a certain security standard. As a pilot there is a move to reissue all pilot license with new security standards. When my passport comes up for renewal I am sure there will be a need for more information. I am sure CDL’s will follow suit. All of these cards will carry biometric information and swipe strips.

Go to the hospital, swipe the card. Go to the airport and they already swipe your passport. I am troubled when a government has the ability to track all of my activities and feels the need for me to constantly prove I am a loyal citizen.

Renee March 18, 2006 at 9:39 am

Here in New Jersey, I had to provide 4 different documents to prove my identity when renewing my driver’s license. I could show items like current license, passport, soc. Sec. card, bank statement, utility bill, property tax bill, etc. Interestingly, a public assistance card counts as proof of identity. Suffice it to say, it takes a lot longer to renew your license with all these requirements, though I know it’s being done to root out illegal aliens, for security purposes. I suspect that the new Medicaid citizenship rules are being done partly for the same security reasons.

One issue that has come up here in New Jersey is how well-trained the clerks at the Motor Vehicle commission are at spotting fake documents. I mean, the woman who checked mine wasn’t exactly an FBI agent; she was a government clerk. So, how well will Medicaid employees be at spotting fake birth certificates or fake passports?

tina March 18, 2006 at 12:24 pm

Early in my twenties I was on medicaid breifly as a single mom. I got kicked off as I got to pick betwen attending my biochem final exam or meeting with the paperwork nazis down at the medicaid office. I left 14 messages and sat on hold for about four hours all told only to be kicked off as noone would help me reschedule. That’s how the government “fixes” programs like medicaid. You make it very difficult to use them.

So what happens when you have a single mom with no insurance? I paid out of pocket. I had very little money and would put off taking my three year olf to the dr as I couldn’t come up with fifty bucks for an office visit. Its a hard choice to make between a dr visit and a roof over your head.

I have a graduate degree and good insurance now, however I still feel the pain of those who do not. have any of you guys stopped to think about the children who suffer from programs like this. As for all the complaining about the “illegals” quit whining. I have lived in Texas my whole life and the first generation immigrants and illegals work thier butts off and get paid crap for it. They are in the same boat with some third of legal citizens who also have no health insurance in Texas. They get what they can from the government as , no matter how much they want to, they can’t afford the dr and hospital bills.

arf March 18, 2006 at 3:27 pm

So, db……..you get a lot of illegal aliens at the Birmingham VA?

Guy June 26, 2006 at 5:39 am

I’m a legal allien, I pay medicare taxes, I’d quite happily stop paying them if you want to deny me any chance of medicare/medicaid when i retire and might need it.

DCS March 13, 2007 at 11:29 am

I wonder if anyone has experienced trying to qualify for health care in a European country. Not just a one time only encounter, but to be a participant. I bet they require all kinds of documentation of residency. Why is it so unreasonable to ask the same of foreign nationals here? And I agree with some of the other posters that obtaining birth certificate information is not that difficult. Please stop playing the race card. It’s really been overused.

clay July 19, 2008 at 7:39 am

Hi there- appreciated your insights. Your voice might be a good one for a Medicaid newsletter i publish. If you’re interested in participating/contributing, send me an email.

Erica March 4, 2010 at 9:53 pm

So, not a lot of non-citizens get medicaid, huh? Spent any time in a social security office or welfare office lately? I have.
I worked for DSHS (Washington State’s welfare system) for 11 1/2 years. I did non-grant medical, including SSI. Here’s how it works: people from Russia, Bosnia, and other European countries contact World Relief. World Relief helps them get into the US. Before these people have even stepped foot in this country, World Relief has scheduled appointments for them at the social security office and also at the welfare office in the area where they plan to locate them.

When these people come into the office, a World Relief worker comes with them and we pay them $25.00 to “interpret” for us. We ask the usual questions: “do you have any stocks, bonds, real estate, bank accounts, personal property” etc. etc. to which the World Relief worker says “no.” Notice that they don’t even bother asking the applicant. You then ask
“why did you come into this country?” (This part makes steam come out of my ears). The World Relief worker says “he (or she) came here to retire.” RETIRE!!!! No, I’m not lying. They are also, by the way, extremely rude, glaring at you during the entire interview with this “I’m so much better than you” look on their face, like you are something they have to scrape off of their feet. Did I mention that these people completely PISS ME OFF?

Guess what happens next? We give the loser from another country who came here soley to sponge off of us a $600.00 check (or more), every month. They also get low-income housing, free medical (no co-pays), and free food stamps.
Isn’t that nice of us?

This scenario plays out hundreds (if not thousands) of times every day in this country and every month we hand out free money, medical and foodstamps to people who never lived here a day in their life other than when they came here to have us support them during their “retirements.”

Still wondering why we are running out of money? I’m not. I’m 44, so I’m guessing that my social security fund, which I’ve been paying into for the last 28 years, has been given to a Russian or a Serb, or a Croatian, or . . . . . . and I won’t be seeing it.

Thinking that illegals are NOT taking a huge amount of money from the system is just plain dumb.
Regaridng your comment about it being difficult for US citizens to get ID, that’s a CROCK of you-know-what. In the entire time I worked at DSHS, there were a grand total of ZERO times we couldn’t come up with ID for someone to get them qualified for these programs. These people have relatives, hospitals keep birth certificates, states keep records of births, deaths, etc., so there is always a way.

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