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New Survey Finds 3 To 5 Million Citizens’ Medicaid Coverage Jeopardized By Budget Reconciliation Bill

On February 1, the House of Representatives is scheduled to vote on the budget reconciliation agreement, which contains a little-noticed mandate requiring U.S. citizens covered by Medicaid to prove their citizenship by submitting a birth certificate or passport or lose their Medicaid coverage. While the provision was intended by its sponsors to keep illegal immigrants from fraudulently enrolling in Medicaid, a new survey demonstrates that it will have unexpectedly large consequences for the health coverage of U.S. citizens, including children, who lack these documents.

Data from a new nationally representative telephone survey of 2,026 adults, commissioned by the Center on Budget and Policy Priorities and conducted by the Opinion Research Corporation between January 12 and January 16, reveal that the new requirement could jeopardize the health insurance coverage of millions of low-income U.S. citizens. Key findings from the survey include:

  • About 1.7 million U.S.-born adults on Medicaid could find their coverage in jeopardy. About one in every twelve (8 percent) U.S.-born adults age 18 or older who have incomes below $25,000 report they do not have a U.S. passport or U.S. birth certificate in their possession. This indicates that about 1.7 million U.S.-born adults covered by Medicaid could lose their health insurance because of the new requirement or experience delays in obtaining coverage as they attempt to secure these documents.
  • Between 1.4 and 2.9 million U.S.-born children on Medicaid would be at risk. More than one-tenth of U.S.-born adults with children who have incomes below $25,000 reported they did not have a birth certificate or passport for at least one of their children. This indicates that between 1.4 and 2.9 million children enrolled in Medicaid apparently do not have the paperwork required.
  • Taken together, approximately 3.2 to 4.6 million U.S.-born citizens now on Medicaid would be at risk of losing coverage because they do not have a U.S. passport or birth certificate readily available.
  • Risks are greatest for African Americans, senior citizens, and rural residents. Some types of citizens would shoulder a greater risk of losing Medicaid than others because they are less likely to have the required documents. While 5.7 percent of all adults in the survey (i.e., adults at all income levels) reported they lack these documents, the percentages were larger for certain groups:
    • African American adults (9 percent lack required documents)
    • Senior citizens 65 or older (7 percent lack required documents)
    • Adults without a high school diploma (9 percent lack required documents)
    • Adults living in rural areas (9 percent lack required documents)

The risks posed by the new requirement are particularly problematic given that there is no evidence that illegal immigrants are fraudulently enrolling in Medicaid by claiming to be citizens. A comprehensive study conducted by the Department of Health and Human Service’s Inspector General in 2005 did not reveal evidence of a problem; accordingly, the Inspector General did not recommend the policies that Congress now appears poised to adopt.