September 25, 2007
CHARGE THAT BIPARTISAN SCHIP COMPROMISE BILL
AIDS UNDOCUMENTED IMMIGRANTS IS FALSE
Some opponents of the bipartisan SCHIP compromise
legislation are charging that the bill opens Medicaid and the State Children’s
Health Insurance Program (SCHIP) to illegal immigrants. This charge is
false.
The
Provision at Issue
The charge revolves around a provision of the new
legislation that is designed to remedy serious problems that have arisen in the
wake of a poorly designed provision enacted in 2006. The provision enacted
in 2006 has turned out to impose more burdensome requirements on U.S. citizens
applying for Medicaid than on eligible legal immigrants who apply, and has
caused thousands of poor, eligible citizen children and parents to be denied
entry into Medicaid, or to have their entry into the program delayed. Many
of these children and parents became or remained uninsured as a result.
(Note: The compromise legislation
does not include a House-passed provision that would have given states an
option to cover legal immigrant children and pregnant women during their
first five years in the United States. Such children and pregnant women are
currently ineligible for SCHIP and Medicaid; they would remain ineligible under
the compromise legislation.)
Background
Undocumented immigrants have never
been eligible for Medicaid (other than for some emergency medical care) or
SCHIP. Eligible legal immigrants have always been required to provide various
documents to prove that they have legal status and that their particular legal
status allows them to qualify for Medicaid under federal law. In addition, any
citizens whose citizenship is in question have always been required to prove
it. In 2005, Dr. Mark McClellan, then-Administrator of the Centers for Medicare
and Medicaid Services (CMS), wrote that this policy “allows states to enroll
eligible individuals while preserving program integrity.”
In 2006, however, Congress changed
the law. A proposal authored by Rep. Nathan Deal and the late Rep. Charles
Norwood requires every citizen child and parent receiving or applying for
Medicaid to provide an original birth certificate, passport, or similar document
to prove his or her citizenship. Congress enacted the provision even though Dr.
McClellan had indicated there was no evidence it was needed and the Bush
administration did not request it.
Supporters said the provision was
necessary to keep undocumented immigrants out of Medicaid and that it would have
no impact on citizens. Studying the issue in 2005, however, the Department of
Health and Human Services’ (HHS) Inspector General did not find evidence of a
problem.
As Dr. McClellan, who was CMS Administrator at the time, noted concerning the
Inspector General’s report, “The report does not find particular problems
regarding false allegations of citizenship, nor are we aware of any.”
Furthermore, the results of the
provision have proved just the opposite of what Rep. Deal anticipated: Tens of
thousands of children who are U.S. citizens have been shut out of the program
because their parents lacked ready access to a birth certificate or passport,
while virtually no undocumented immigrants have been identified.
- Numerous states have reported that,
due to the new requirement, thousands of U.S. citizen children have been removed
from, or denied entry into, Medicaid. Many of them apparently became or
remained uninsured. The Government Accountability Office (GAO), the House
Oversight and Government Reform Committee, and the Center on Budget and Policy
Priorities have reported these results based on data that the states collected.
- The six states that have examined this
issue in greatest detail found they have spent $17 million so far to administer
the burdensome requirement, have denied health insurance to tens of thousands of
needy children and parents as a result, and have identified a grand total of
eight undocumented individuals, whom they may have caught under the previous
procedures anyway.
For example, the number of low-income children insured through Medicaid has
dropped 11,000 in Virginia and 14,000 in Kansas due to the new requirements;
each state identified one applicant who incorrectly claimed to be a citizen.
- The three states that collected data
by racial/ethnic group have found that the children losing coverage due to the
requirement are overwhelmingly non-Hispanic white and non-Hispanic black
children. Hispanic children are far less affected. In Virginia, for example,
enrollment has fallen significantly among white and black children since the
requirement took effect, while it actually has climbed among Hispanic children.
This would not be occurring if the provision were affecting undocumented
immigrants; an estimated 78 percent of undocumented immigrants are from Mexico,
Central America, or South America, according to the respected Pew Hispanic
Center.
Governors have sharply criticized the
provision. In a letter this summer to leaders of both parties on the House
Energy and Commerce Committee, California Gov. Arnold Schwarzenegger wrote that
the provision has increased state administrative costs, put barriers in the way
of eligible applicants, and “created a situation where U.S. citizens actually
have fewer rights than non-citizens when applying for Medicaid benefits”
(in that the documentation requirements now imposed on citizens have proved more
difficult for many of them to comply with than the substantial documentation
requirements placed on eligible legal immigrants).
The
Compromise Provision
A provision of the SCHIP compromise
legislation is designed to give states increased flexibility to address the
unintended problems that the provision enacted in 2006 has created, without
allowing undocumented immigrants into Medicaid. The provision also tightens
SCHIP — by extending these requirements into SCHIP for the first time. The
compromise language is similar to language originally included in the Senate
bill.
Why the Social Security
Matching Requirement
Should Keep Out Undocumented Immigrants
Social Security numbers are not issued to
undocumented immigrants. Thus, a cross-match between Medicaid records and
Social Security numbers can help to identify any undocumented immigrants
who may have fraudulently applied for Medicaid benefits.
Some opponents of the SCHIP legislation are
citing a Congressional Research Service observation that having a Social
Security card does not itself denote citizenship. That is true, and is
part of the reason why the SCHIP compromise requires states to verify
information received from applicants against the Social Security database.
Rather than rely on a card, states choosing the new option will have to
verify that applicants’ claims match official United States records of
name, SSN and citizenship status.
It is also true that having a valid Social
Security number does not prove you are citizen because some legal
immigrants are granted Social Security numbers if they are authorized to
work here. Federal Medicaid and SCHIP has long required, however, that
legal immigrants who apply for Medicaid or SCHIP must submit immigration
documents proving their legal immigration status and demonstrating that
they are in a particular legal immigrant category that enables them to
qualify for Medicaid. Immigrants who are lawful permanent residents will
still be required to submit their immigration documents; having a valid
Social Security number will not be sufficient for them to qualify.
A cross-match between Medicaid and Social
Security number data thus should provide an efficient and effective
mechanism to screen out undocumented immigrants, which was the goal of the
provision enacted in 2006. |
What
the Compromise Provision on Citizenship Documentation Does
The SCHIP compromise retains the
citizenship documentation requirement added to Medicaid in 2006 and extends it
to SCHIP, while giving states a new way to ensure that all individuals applying
for benefits are who they say they are.
- Parents in all states would be
required to sign, under penalty of perjury, that their children are U.S.
citizens and to provide the children's Social Security numbers. States would
then have the option of either continuing to apply the documentation requirement
enacted in 2006 or of verifying each applicant’s and recipient’s name and Social
Security number with the Social Security Administration (SSA). States electing
the latter approach would provide to SSA the Social Security numbers of
individuals applying for Medicaid and SCHIP. If the information provided by the
applicant did not match SSA records, the applicant would have up to 90 days to
straighten out the problem with SSA or to provide documentation of citizenship
in accordance with the requirements enacted last year. Those not doing so would
be denied coverage.
- This approach protects program
integrity, because Social Security numbers are not issued to undocumented
immigrants. Individuals who report false Social Security numbers should be
readily identified by this cross-match. (Claims that this approach would be
ineffective because some legal immigrants can legitimately obtain Social
Security numbers are off the mark; legal immigrants who apply for
Medicaid or SCHIP must do far more than prove they have a valid Social Security
number. They must prove, with immigration documents, that they have a specific
legal immigrant status that allows them to qualify for Medicaid or SCHIP. For
further discussion of the efficacy of this approach, see the box above.)
- States that elect this option also
would be required to provide information to HHS on the percentage of invalid
names and numbers — and states would be penalized financially if the
percentage of invalid cases exceeded 3 percent.
This provision of the new legislation
would be substantially more stringent than the provisions that governed
Medicaid prior to 2006 — and that did so evidently without causing problems or
allowing undocumented immigrants to participate.
- Estimates that CBO developed for the
Senate SCHIP bill indicate that about 100,000 eligible low-income children who
would not receive Medicaid coverage under current law — because of the
unintended side-effects of last year’s legislation — would be covered due
to the new provision. Contrary to the charge by Rep. Nathan Deal that this
provision is a “multi-billion dollar giveaway to illegal aliens,” CBO indicated
that nearly all of those who would receive Medicaid coverage as a result of this
provision would be U.S. citizens.
- The compromise provision also would
reduce federal and state administrative costs, by allowing states to use more
cost-efficient procedures to assure that undocumented immigrants do not receive
Medicaid.
- This approach thus contains strong safeguards
against undocumented immigrants obtaining benefits, and does so without
perpetuating the needless and improper denial of coverage to tens of thousands
of low-income citizen children who have lost or been denied health care
coverage due to the unintended effects of the provision enacted in 2006.
What
the Compromise Provision Does Not Do
- It makes no undocumented immigrants eligible.
- The new legislation also makes clear that
nothing in it allows federal funding to be spent on undocumented immigrants.
The new provision responds to requests from
governors in a number of states – including Oklahoma, Washington, New Mexico,
Wisconsin, Michigan, Oregon, Virginia, Maryland, Pennsylvania, New Jersey, New
York, Massachusetts, and California, among others – for greater flexibility in
this area. The National Association of State Medicaid Directors also has called
for such a change.
End Notes:
Rep. Nathan Deal, “Oppose the Multi-Billion-Dollar Giveaway to Illegal Aliens:
Vote No on H.R.976,” Sept. 25, 2007.
Memorandum from Mark B. McClellan to Daniel R. Levinson, Acting Inspector
General, April 8, 2005, printed as Appendix D in Office of Inspector General,
U.S. Department of Health and Human Services, “Self-declaration of U.S.
Citizenship for Medicaid,” June 2005.
Office of Inspector General, U.S. Department of Health and Human Services,
“Self-declaration of U.S. Citizenship for Medicaid,” June 2005.
McClellan, op. cit.
Government Accountability Office, States Reported That Citizenship
Documentation Requirement Resulted in Enrollment Declines for Eligible Citizens
and Posed Administrative Burdens, June 2007; “Medicaid Citizenship
Documentation Requirements Deny Coverage to Citizens And Cost Taxpayers
Millions,” Majority Staff, Committee on Oversight and Government Reform, July
24, 2007; Donna Cohen Ross, “Medicaid
Requirement Disproportionately Harms Non-Hispanics, State Data Show,”
Center On Budget and Policy Priorities, July 10, 2007, and “New
Medicaid Citizenship Documentation Requirement Is Taking A Toll,” Center on
Budget and Policy Priorities, March 13, 2007.
Committee on Oversight and Government Reform, op. cit.
Donna Cohen Ross, “Medicaid
Requirement Disproportionately Harms Non-Hispanics, State Data Show,” op.
cit.
An estimated 13 percent are from Asia, and 9 percent are from Europe, Africa,
and other areas. Jeff Passel, “The Size and Characteristics of the
Unauthorized Migrant Population in the United States,” Pew Hispanic Center,
March 2006.
Governor Arnold Schwarzenegger, Letter to Reps. John Dingell, Joe Barton, Frank
Pallone, and Nathan Deal, June 5, 2007.
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