Authorities argue over providing birth control to illegal immigrants
By Clea Benson, McClatchy Newspapers
April 4, 2007

SACRAMENTO — The Bush administration is pressing California to ensure that poor women are legal residents or citizens before giving them free birth control, though the policy could cost the federal government hundreds of millions of dollars a year.

State officials say requiring women to present documents to get family planning services could result in more unintended pregnancies, including among undocumented immigrants who would qualify for federally funded prenatal care and whose children would be U.S. citizens if they were born here.

Also, state officials say, it would cost the federal government and the state almost double the $261 annual price of the birth control per recipient just to conduct each background check.

The difference of opinion is stalling an agreement with the federal government, known as a waiver, that would allow Medicaid funding to continue for the state's 10-year-old family planning program. The Bush administration has been extending the current agreement on a month-to-month basis while the debate continues.

"They just basically want us to check the immigration status of each and every person," said Stan Rosenstein, director of Medi-Cal, a $36 billion program jointly funded by the state and with federal Medicaid dollars. "That has been their position, and that's where we are at an impasse."

The Bush administration has also stopped paying for mammograms and some services related to sexually transmitted diseases under the California Family Planning, Access, Care and Treatment program. Gov. Arnold Schwarzenegger has proposed using about $2.5 million in state funds to cover those services, a plan that is likely to get support from the Democrat-controlled Legislature.

Representatives of the Center for Medicare and Medicaid Services in Washington, the administrative agency in charge of Medicaid, did not respond to requests for comment about the citizenship checks.

In an e-mail, CMS spokesman Jack Nelligan said the state should never have been billing the federal government for mammography and some other disease treatments.

The debate over family planning services is just one of the hurdles states have faced in implementing the 2006 Deficit Reduction Act, a federal law requiring Medicaid recipients to prove they are in the country legally by showing their birth certificates or other documents before they can get benefits. Despite the new law, the federal government does cover limited services for undocumented immigrants, including prenatal care in some states.

California is about to implement the background check requirements for the more than 6 million low-income state residents who receive comprehensive insurance coverage through Medi-Cal. Other states have reported difficulties ensuring that all qualified citizens could find the documents they need.

For the family planning services, which are limited to birth control and disease testing, California has never required people to enroll in Medi-Cal.

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