I first wrote about this issue last year. Medicaid and citizenship proof In that post and 2 subsequent posts I predicted the outcome of this new rule. More on medicaid and birth certificates and Continuing thoughts on Medicaid.
Today’s NY Times documents that my fears were accurate – Citizens Who Lack Papers Lose Medicaid
Some state officials say the Bush administration went beyond the law in some ways, for example, by requiring people to submit original documents or copies certified by the issuing agency.
“The largest adverse effect of this policy has been on people who are American citizens,†said Kevin W. Concannon, director of the Department of Human Services in Iowa, where the number of Medicaid recipients dropped by 5,700 in the second half of 2006, to 92,880, after rising for five years. “We have not turned up many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere else in Iowa,†Mr. Concannon said.
Jeff Nelligan, a spokesman for the federal Centers for Medicare and Medicaid Services, said the new rule was “intended to ensure that Medicaid beneficiaries are citizens without imposing undue burdens on them†or on states. “We are not aware of any data that shows there are significant barriers to enrollment,†he said. “But if states are experiencing difficulties, they should bring them to our attention.â€
In Florida, the number of children on Medicaid declined by 63,000, to 1.2 million, from July 2006 to January of this year.
“We’ve seen an increase in the number of people who don’t qualify for Medicaid because they cannot produce proof of citizenship,†said Albert A. Zimmerman, a spokesman for the Florida Department of Children and Families. “Nearly all of these people are American citizens.â€
If I could predict this outcome a year ago, why could our legislators not see? Of course, I try to think through problems considering both the intended and unintended consequences of my decisions. I try to imagine what can go wrong as well as what can go right. I believe that is my medical training – preparing for all the possibilities.
This rule is dumb. It was dumb last year before we had the evidence of its stupidity. Now we have clear evidence. But now the bureaucracy has run amok. Who will fix this mistake? Congress is great at passing dumb laws, but not very good at repealing them. Shame, shame, shame!!!!
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7 Responses to New Medicaid rule blocks citizens from coverage
Bob Condon
March 12th, 2007 at 11:12 am
State welfare officials assert that US citizens are being denied benefits because they can’t prove they are citizens. So, how do the state officials know that those denied are, in fact, citizens?
John Frum
March 12th, 2007 at 2:20 pm
I – too – had the exact realization when I heard about these changes. I am a Administrative Hearing Officer (basically a limited role judge)who hears due process Medicaid denial/termination appeals in the Southeast.
Saw the Times article this morning . . . looking through my case for tomorrow: a woman who was moved by the Red Cross following a hurricane has children born in 2 states and can not afford to get the birth certficates until after she gets her tax returns.
The law is the law and I am bound to abide by it and rule accordingly.
As obvious and predictable as this result was, I really wonder whether this was an intended or unintended consequence. Regardless, this has nothing to do with the stated policy objective: keeping undocumented aliens off the Medicaid roles (which is actually quite rare – many children of aliens – citizens of the US are on Medicaid but I have never seen a case out of 500ish where an undocumented alien was terminated).
Bob: go to Appalachia or the inner city. Unless there are hordes of tricky Canadians or Australians who can disguise their accent at will, there is no doubt most of these people are citizens. And read the NYT article. The issue is the strictness of the verification requirements. Babies have no passports or driver’s licenses so they have to have a birth certficate. If a copy will not do, then they will need to have an original or one that is certified.
Do you have your original/certified birth certificate on hand?
How do I know you are a citizen?
John Frum
March 12th, 2007 at 2:26 pm
To rephrase/clarify: I have never seen an undocumented alien on Medicaid PERIOD. I would only see this if they appealed being terminated or denied.
I have seen many denied (even before these changes).
Never seen anyone actually on Medicaid.
CardioNP
March 12th, 2007 at 9:34 pm
Mr. Frum –
Wouldn’t surprise me that not many illegals are seeking medicaid in Appalachia.
If you lived in a border state such as CA, TX or AZ, then suspect that you would encounter MANY illegal aliens on Medicaid.
I have a friend working at an LA County Med Center; I’d guess that at least half of her pt population is illegal and many are on Medi-Cal because they have cancer diagnoses.
tina
March 13th, 2007 at 1:01 am
Of course these requirements were put in place to keep citizens off medicaid. The harder it is to apply and stay current on documentation, the less people will use the program. You cut expenditures indirectly. If you can’t see that then likely you also think credit card companies are all about the betterment of society and banks just want to take care of you and your family.
In the past-in TX, during the bush times- this was done by having mandetory seven hours office waits every other month and two hour waits every month. Plus about 25 pages of paperwork that needed to be resubmitted on a monthly or bimonthly basis. Also about 90 minute hold times if you tried to call and reschedule the above mentioned visits. I found the medicaid office a great place to study from.
In contrast the WIC and ECI office had ten minute wait times, amazingly friendly helpful caring staff and did everything they could to help parents find resources for thier kids.
As for illegals? Most of the hispanic population I saw had all the same documents as I did. In the end you can debate the about “the right to health care” for adults all you want but children are innocents and should automatically qualify for some sort of medicaid. We recognize as a society the ads of WIC, ECI and prenatal care. Do we abandon them after they are born with respect to basic health care?
Bob Condon
March 13th, 2007 at 11:44 pm
John Frum: I have read the NYT article in its entirety. I have spent time in Appalachia as well as the inner city neighborhooods of five major cities. I have my birth certificate (original), as well as those of other family members in my files. I can document for you my citizenship. All of which is not germane to the issue. Answering my question requires an ability to think logically. The question I posed remains unanswered, despite all the blather.
John Frum
March 15th, 2007 at 8:04 am
Bobby:
You are of course correct – in the most literal meaningless sense possible.
One way they could KNOW would be if these same people satisfied the state’s prior verification rerquirements (say an uncertified but otherwise valid birth certificate), yet could not pass muster under these new requirements.
Or they are all named Davis, Smith, Whitey McWhiterson, etc. . . .or officials dated said person’s mother and knew their grandparents and watched every single one being born.
Is the default rule you are not a citizen until you prove otherwise? (That was the point of my satirical question about your status – which obviously flew right over your head).
The question you posed is trifling and of little impart, in the manner of “How do I know you are really not a creation of my mind?”
If you are sincerely interested in the “how” of it, then I apologize for my tone. If you are implying that these people really aren’t citizens, then I would put the burden on you to show they are not.