CHANGE IN MEDICAID RULES "COMMENDABLE,"
BUT FURTHER CHANGES NEEDED TO PREVENT LOSS OF HEALTH CARE COVERAGE BY POOR CHILDREN AND PARENTS
A July 6 announcement by the Department of Health and
Human Services that it will exempt 8 million elderly or disabled people from
new citizenship documentation requirements for receiving Medicaid “is an
important and commendable action that will prevent many vulnerable low-income
citizens from losing essential health care services for which they are
eligible,” according to Robert Greenstein, executive director of the Center on
Budget and Policy Priorities.
But even with these exemptions, “the new requirements
still are likely to force significant numbers of U.S. citizens who are fully
eligible for Medicaid — primarily poor children and parents — to go without
health care, because they are waiting for paperwork from a government
bureaucracy or are unable to get the paperwork,” said Greenstein. He noted
that HHS could have addressed many of these problems as well, but has not done
so.
The announcement means that states can exempt low-income
elderly people and people with disabilities who are eligible for both Medicare
and Medicaid or are receiving Supplemental Security Income benefits. These
individuals have already been subject to documentation requirements.
The announcement also gives states the option of
conducting upfront data matches with state vital records to obtain birth
certificates. Low-income individuals whose birth certificates are secured
through a data match will not need to obtain and submit certified paper copies
of their certificates. This new option will primarily help individuals who
are applying for, or receiving, Medicaid in the state where they were born.
It is unlikely to help many people born in other states.
Several major categories of eligible low-income citizens
who could have been protected, however, remain at risk of losing health care
or having health care coverage delayed, even if they are sick, Greenstein
said.
One such category is low-income children in foster care.
States already verified the citizenship of about half of the children in
foster care when they determined these children’s eligibility for federal
foster care payments. Nevertheless, the new regulations require these
children’s citizenship to be proven anew, and deny Medicaid coverage to these
children until that is accomplished.
Obtaining birth certificates on a timely basis for
children in foster care can be difficult because of the chaotic family
backgrounds of many of these children and for other reasons. These problems
are compounded when children live in a state other than the state in which
they were born; the foster parents of such children may not know where to
apply to get the child’s birth certificate, and once they do apply, they may
have to wait for extended periods of time
until the government agencies provide certified copies of the birth certificates
Under the new regulations, many such children could be forced to go without
health care in the meantime. A new report, “Children in
Foster Care May Have to Delay Health Care Because of Federal Regulations on
Citizenship Requirement” <https://www.cbpp.org/7-7-06health.htm>
discusses these issues in further detail.
“These children are among
the most vulnerable members of our society. Many of them have been victims of
abuse or neglect. To deny them health care coverage for bureaucratic reasons
that readily could be solved, and to refuse them coverage while their documents
are being located, is not defensible,” Greenstein said. “HHS should act swiftly
to change course here and protect these children.”
Greenstein noted that under
the regulations, new applicants whose citizenship is not in doubt, and
who are simply awaiting receipt of a birth certificate that proves their
citizenship, are to be denied coverage until the birth certificate is provided.
“HHS could have provided coverage for an interim period for poor children,
parents, and elderly and disabled people who meet all eligibility criteria, have
applied for a birth certificate or similar document, and are waiting for a
government bureaucracy to produce it,” Greenstein noted. Federal officials
have so far declined to take this step.
Obtaining a birth certificate
from the certifying agency can take weeks or months in the case of some large
states. In California, for example, the wait can be as long as ten weeks.
“Sick children could be
denied health care while a government agency is locating their documents,”
Greenstein observed.
A solution in search of a problem
The new rule is based on
legislation enacted earlier this year that imposed the new documentation
requirement on U.S. citizens. Supporters of the new requirement contend
that it is needed to prevent illegal immigrants from obtaining Medicaid by
falsely claiming to be citizens.
A comprehensive
investigation by the Department of Health and Human Services’ Office of the
Inspector General, however, found no substantial evidence that such a problem
exists. Legal immigrants are already required to provide proof of their legal
immigrant status. And while most states have allowed citizen applicants to
attest, under penalty of perjury, that they are citizens, these states have
required documentation from citizen applicants if there is reason to question an
applicant’s truthfulness. The HHS report found no problems with this
longstanding approach, which states will now have to discard and replace with
the new, more cumbersome requirements and procedures.
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The Center on Budget and Policy Priorities is a nonprofit, nonpartisan research organization and policy institute that conducts research and analysis on a range of government policies and programs. It is supported primarily by foundation grants. |