Thread: County awaits word on Medi-Cal ID dilemma

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County awaits word on Medi-Cal ID dilemma
Starting Saturday, recipients must prove citizenship

By Teresa Rochester, dtrochester@VenturaCountyStar.com
June 26, 2006

A new federal law requiring proof of citizenship from Medi-Cal recipients goes into effect at the end of the week, but Ventura County officials are still waiting for the state to tell them how to implement the change.

The state agency that runs the program is still figuring out how to institute the federal rule designed to block illegal immigrants from receiving full Medi-Cal benefits.

Medi-Cal, funded by the federal government and the states, provides health insurance for low-income people, including senior citizens, children and people with disabilities.

Officials say they are quickly working to implement the changes, but have concerns about how the new rule might impact the 6.8 million Medi-Cal recipients statewide. Patient advocates fear that thousands will be wrongly forced off the rolls and that it will result in an administrative nightmare.

"We're very worried about that — that people who just can't get their hand on that documentation that says they are citizens will fall from the rolls and be uninsured," said Sherreta Lane, vice president of reimbursement and economic analysis for the California Hospital Association.

Implementing the federal law in California depends both on the passage of a bill codifying the new rules and creation of a workable plan of action. The bill is pending.

State officials won't say if they will miss the federal deadline, only that they are working as fast as they can.

The federal government did not release guidelines on enacting its citizenship rule until June 9, which has caused the state's last-minute sprint.

"We're really looking at understanding them," said Stan Rosenstein, deputy director of Medical Care Services for the state. "Then we will figure out how to implement them."

Rosenstein said the state wants to move forward in a way that gives people a chance to get documentation.

In a brief issued in May, the California Budget Project estimated that 650,000 Californians may lack birth certificates and passports that could be used to prove citizenship and verify identification.

Rosenstein said he would like the state to be able to use its database of birth certificates to match with people renewing or applying for Medi-Cal. Under the guidelines presented by the federal government, data sets can only be used as a last-ditch effort if a person is unable to find documents.

Locally, county officials have been left with little to do but alert their employees of the change and try to warn beneficiaries.

"We want to do the best we can by our clients, but within the law," said Curtis Updike, deputy director of Ventura County's Human Services Agency. "We are already working on information notices for our clients that these laws are going into effect."

Enough time for changes

The United States Centers for Medicaid and Medicare is confident that the state has enough time to enact the changes, regional spokesman Jack Cheevers said.

When Medi-Cal was developed in the 1960s, it was not designed to cover all low-income people, but those in certain categories, such as children under the age of 21, adults 65 years old and older, the disabled and pregnant women.

When Californians apply for Medi-Cal, which is called Medicaid by the federal government, they have to present Social Security numbers for full benefits and sign a declaration of their citizenship or immigration under penalty of perjury, according to the state's Department of Health Services.

The federal government wants more in order to ensure that illegal immigrants are not draining the system. The new rule, part of the Federal Deficit Reduction Act, was signed into law by President Bush on Feb. 8 and goes into effect Saturday.

Some of the guidelines offered by the federal government to prove citizenship and identity include a U.S. passport, a birth certificate, adoption decree, a current state driver's license, a certificate of American Indian blood and, in rare cases, a sworn affidavit signed by two people, one of whom cannot be a relative. There are 29 documents that can be used to verify identification and citizenship.

People will have to show the documents when they renew their benefits or apply for the first time.

"The idea here is not to boot people off the Medicaid rolls," Cheevers said. "Every effort is being made to ensure that people who are U.S. citizens are not kicked off the rolls."

The federal government has the ability to withhold all or part of the federal match money that the states receive if the states do not comply with the federal statute.

Cheevers said he didn't think that there would be draconian penalties for slight infractions but he thinks that California would be well-advised to implement the changes.

New rules a burden?

But advocates fear that people will be afraid to come forward, resulting in more people heading to the emergency room for their care.

"The clients of county mental health services, immigrant or not, often don't have documentation," said Patricia Ryan, executive director of the California Mental Health Directors Association. "A lot of them are homeless or don't have stable living situations. Are they going to be denied outpatient services until they get so bad that they need emergency medical services?"

David Carroll, research director for the California Budget Project, said the alternatives that the government offered in the guidelines were positive but the new rules still present a heavy burden on individuals in terms of access and cost.

Legal immigrants aren't affected by the law because they have to show green cards and other documentation now.

A federal mandate allows undocumented immigrants to receive limited-scope Medi-Cal benefits, which include emergency services, pregnancy-related services, nursing home care, and some breast and cervical cancer services, Rosenstein noted.

The state says it has safeguards in place to ensure that people aren't taking advantage of the system. Fraud investigators review suspect cases, and there is a rigorous Social Security verification process in place.

"We don't believe there are very many people enrolled as citizens who are illegally here," Rosenstein said. "They were concerned that even a small number is too many."

At Ventura County Medical Center, 52 percent of inpatients are on Medi-Cal, while 60 percent of outpatients are beneficiaries, county Public Health Director Linda Henderson said.

Internal education has already begun in Henderson's agency.

"Obviously, the whole purpose here is to not have any barrier here for constituents," she said.

Updike predicts that an administrative paper jam will likely occur when people are initially determined ineligible for Medi-Cal but then come back with documentation and have to be added to the system again.

For those pushed off the rolls, Fred Bauermeister of the Free Clinic of Simi Valley envisions that the clinic's waiting room will fill.

"I'm kind of nervous," he said. "More people would need to come here. ... Obviously, if they don't receive care, they end up in the emergency room."

There are 29 documents that can be used to verify identification and citizenship.

If a person can't produce one of these 29, wouldn't it be a little obvious. My lord...29 documents and you need one and these NUTS are worried that somehow, someone, will be left off......GIVE ME A BREAK!!

Officials say they are quickly working to implement the changes, but have concerns about how the new rule might impact the 6.8 million Medi-Cal recipients statewide. Patient advocates fear that thousands will be wrongly forced off the rolls and that it will result in an administrative nightmare.

Than these "officials" need to be booted and the "advocates" deep sixed! Every legal American citizen in this country can prove their legal status outright, or with minimal assistance from IRS or SS records.

"We're very worried about that — that people who just can't get their hand on that documentation that says they are citizens will fall from the rolls and be uninsured," said Sherreta Lane, vice president of reimbursement and economic analysis for the California Hospital Association.

That there are Americans citizens that "cant get their hands on documentation that they are legal citizens" is an total myth!

California voted in a law to allow illegal immigrants to have drivers' license so I imagine they will jam into the DMV rather than the emergency rooms!

According to Lou Dobb's tonight, illegals are flooding DMV in Maryland to get drivers licenses...PATHETIC