Officials disagree on who can make Medicaid decision for illegals

By MARK ANDERSEN / Lincoln Journal Star | Posted: Thursday, January 28, 2010 6:15 pm | (5) Comments

Nebraska Medicaid could continue to cover prenatal care for poor illegal immigrants, but that must be the Legislature's call, the state's top Medicaid official said Thursday.

"I'm a firm believer in prenatal care," said Vivianne Chaumont, director of the state's division of Medicaid and Long-Term Care, "but the feds make policy. The Legislature makes policy."

In light of LB403, the law approved last year that denies illegal immigrants the right to public benefits, jobs or contracts, Chaumont said she will not assume authority to extend that coverage.

Staff attorneys with Nebraska Appleseed argued that Chaumont could act without official legislative action, which could be important now that the deadline has passed for introducing new bills.

They also questioned Chaumont's invoking of LB403.

During the legislative floor debate over LB403, senators were assured it would not affect Medicaid coverage for unborn children, said Appleseed attorney James Goddard.

Appleseed attorney Jennifer Carter said acting to continue prenatal care for future U.S. citizens was an issue of fiscal responsibility because it prevents avoidable medical tragedies billable to taxpayers.

Chaumont said the Legislature could choose to continue providing prenatal care to illegal residents. Or, she said, it might opt to help more legal residents just above the household income limit for Medicaid eligibility.

Neither the provisions of LB403 nor a Medicaid prohibition against coverage of illegal residents impedes extending the prenatal care. It would require the state to make certain technical changes to its S-CHIP program, the children's health insurance program.

On Jan. 15, the Nebraska Department of Health and Human Services told senators the state was notified that federal law prohibits Medicaid coverage for people who are not documented, except in emergencies.

The federal agency that oversees Medicaid informed state officials on Nov. 30 the state has erroneously awarded Medicaid benefits because it wrongly considered the unborn as a person in determining eligibility.

Because of that, state notices of discontinued coverage will go out to an estimated 1,000 pregnant illegal immigrants and an unknown number of legal residents within a few days, said Todd Reckling, director of the Division of Children and Family Services.

His office is reviewing the Medicaid applications of 6,200 pregnant women to determine which were incorrectly approved for coverage. It's still unknown how many legal residents will be affected.

Chaumont said Thursday the state appears to have applied the incorrect eligibility standards for "longer than anyone here can remember."

She admitted Nebraska could be liable for repaying the federal government for that error, should the Centers for Medicare & Medicaid Services demand it.

Nebraska Appleseed director Becky Gould said she was concerned the option of continuing to provide prenatal care for illegal immigrants had not been communicated in the letter to state senators.

Since the announcement, child advocates have been looking for ways to continue the coverage of prenatal care for illegal immigrants, arguing the denial of prenatal care will injure babies, who will be U.S. citizens by virtue of being born here. Taxpayers would then be liable for those additional health costs.

Dr. Sarah Cada, an OB-GYN and president of the Lancaster County Medical Society, has said the risk of death to a child whose mother did not receive prenatal care is six times greater. Children who survive with brain injuries may need a lifetime of care.

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