New Medicaid Citizenship Rules Challenged Starting July 1, states are supposed to require all Medicaid recipients to prove citizenship in order to receive or keep their benefits. The provision is intended to purge Medicaid of illegal immigrants. But advocates for the poor have filed a lawsuit on behalf of citizens who simply lack the needed documents.

New Medicaid Citizenship Rules Challenged

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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.


And I'm Michele Norris.

A suit was filed in federal court today to block new rules for the Medicaid Health Program for the poor. Those rules, scheduled to take effect Saturday, requires some 50 million people to prove they are U.S. citizens in order to keep their coverage. The aim is prevent illegal immigrants from collecting benefits. But critics say those most likely to lose coverage are people who are on the program legally.

NPR's Julie Rovner has the story.

JULIE ROVNER reporting:

Georgia Republican Congressman Charlie Norwood wrote the requirement, which was included in the massive deficit reduction act Congress passed in February. He said he got the idea watching his governor struggling with the high cost of the Medicaid program, a cost shared between the states and the federal government.

Representative CHARLIE NORWOOD (Republican, Georgia): Frankly, I felt like something needed to be done, because I knew we were spending unbelievable amount of sums on Medicaid for foreigners, people who would come into our country illegally.

ROVNER: That's actually debatable. A report last year from the inspector general of the Department of Health and Human Services found there's not a big problem with illegal immigrants getting on Medicaid. Still, Norwood says, it doesn't hurt to make sure.

Mr. NORWOOD: It didn't seem unreasonable to me for that big and wonderful thing that the generous American people are willing to do, to ask somebody to say well be kind enough to tell us and prove to us you're American citizen. It's simple as that.

ROVNER: But simple is the one thing the new rules are turning out not to be. The specific requirements, issued just two weeks ago, call for documents most Medicaid beneficiaries simply don't have, like a passport.

Ms. STEPHANIE ALTMAN (Health and Disability Advocates, Chicago): I have never met, in my 17 years of legal services, a Medicaid recipient who had a United States passport.

ROVNER: Stephanie Altman is a lawyer with Health and Disability Advocates in Chicago. It's one of a half dozen groups that filed the lawsuit. The plaintiffs are nine Medicaid beneficiaries who won't be able to meet the citizenship documentation requirements. Altman describes the situation for one of those plaintiffs, George Crawford. He lives in a nursing home in Rockford, Illinois.

Ms. ALTMAN: He has a tube. He's had two strokes. He's got a trustee whose been searching for his documents. He has no birth certificate. They don't know where he was born. He doesn't have a government photo I.D. in his billfold. He has no living relatives. He's over 80 years old and he's been on Medicaid for years.

ROVNER: But the rules don't make exceptions for people like George Crawford. If beneficiaries can't provide a passport or actual immigration papers, they have to prove their citizenship status and identity some other way, with an original certified birth certificate, for example, plus a government issued photo I.D. like a driver's license.

In some cases, however, those documents aren't available either. Ruby Bell, another plaintiff in the suit, was born in a small town in Arkansas on November 11, 1911, but she was born at home so she's not sure she ever had a birth certificate.

Ms. ALTMAN: Her daughter has called the Little Rock clerk's office and their records only go back on paper to 1914. So they don't even have records back to the year she was born even if she had had a birth certificate issued.

ROVNER: And many African Americans born in the South before the 1940s had to be born at home because the local hospital was for whites only. So they never got a birth certificate. Others likely to have trouble finding or affording needed documents include foster and adopted children and those displaced by Hurricane Katrina or other natural disasters.

The new rules have state governments scrambling, too. They could lose billions of dollars in federal matching payments if they fail to certify citizenship. Elaine Ryan is the deputy director of the association that represents state Medicaid directors. She says the new rules will require more face-to-face interviews, something states have been trying to eliminate. The State of Washington, for example -

Ms. ELAINE RYAN (American Public Human Services Association): Has estimated that it will cost them, just at the outset, not only five and half million dollars in the first month, but they have to employ 68 new state staff people just to be able to make this kind of eligibility determination.

ROVNER: If the federal judge fails to block the rules, there could be quite a fight between federal Medicaid officials and the states. California, for example, with more than six million Medicaid patients, has to train some 15,000 new eligibility workers. And a spokeswoman for the agency that oversees Medicaid says it's unlikely to be ready to implement the new rules until August at the earliest.

Julie Rovner, NPR News, Washington.

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