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Medicaid rolls decline as new state rules begin

By ANDY MILLER
The Atlanta Journal-Constitution

Published on: 09/30/06

Georgia's Medicaid program lost almost 70,000 in membership in the first four months of 2006, after Georgia launched new rules to control fraud.

Beginning Jan. 1, the state began demanding proof of income and citizenship for people to join or stay on Medicaid. Through April, the government insurance program for about 1.3 million of Georgia's poor and disabled had an enrollment decline of 69,635.

State Medicaid officials said the membership changes throughout the year as people are added and dropped from the rolls. They say the actual number of patients leaving Medicaid during the first four months of the year could be much higher than 69,635.

The officials say they don't know how many dropped out because of the state's tighter checks on income and citizenship, but said the new rules were a key factor in the decrease.

At an August hearing on illegal immigration, held by a U.S. House committee, Abel Ortiz, health policy adviser for Gov. Sonny Perdue, said the decline in Medicaid membership showed ''strong evidence of fraud and abuse.''

"Illegal immigrants are getting onto our social system, and it is busting the bank now," Rep. Charlie Norwood (R-Ga.) said at the hearing. Norwood earlier took his anti-fraud fight national, helping push Congress to pass a law requiring proof of citizenship in all states' Medicaid programs.

Consumer advocates say the new requirements won't snag much fraud, but instead will prevent U.S.-born citizens from getting benefits.

"It's especially sad that many of those losing health coverage are children,'' said consumer health advocate Linda Lowe. The state's policy changes create a paperwork burden for people trying to keep Medicaid, she said. And even a small increase in family income can knock people off Medicaid and into the ranks of the uninsured, Lowe added.

"The state has no basis for saying the decline is a result of fraud,'' she said.

The Medicaid changes come as the illegal immigration issue sizzles across the state and nation. Georgia has the nation's fastest-growing illegal population, estimated at 470,000 by the Department of Homeland Security.

Perdue's stricter rules on Medicaid ''make good sense,'' said John Vinson of Americans for Immigration Control, a national organization that lobbies for enforcement of immigration laws. "It's improper for people illegally in the country to get these benefits, which properly should go to American citizens.''

Many children affected

Medicaid from January through April had a child membership drop of about 50,000, though many may have transferred to new coverage, including PeachCare for Kids, state Medicaid officials said. PeachCare added only about 4,000 during the same period.

The four-month Medicaid figures are the latest the state agency released, but the decline has probably continued through the summer, officials said.

The drop also reflects new restrictions in other Medicaid coverage programs, including those for disabled children and for emergency care to illegal immigrants. During the same period in the previous two years, Medicaid enrollment rose by 1 percent and less than 1 percent, respectively.

State officials said several factors contributed to the 5.3 percent decline in enrollment in Medicaid from January through April. Some families have likely seen their income rise — and thus become ineligible for Medicaid, said Carie Summers, chief financial officer for the Department of Community Health.

Eligibility for Medicaid is determined by income, age, family size and disability. For example, a single mother with one child under the age of 6 must earn no more than $13,044 per year to get Medicaid coverage for her child.

Summers, though, said a key factor in lowering the Medicaid count was the stricter rules verifying citizenship and income.

As of Jan. 1, applicants in Georgia must provide documents such as W-2 forms, pay stubs or income tax returns as proof of income. People also must verify citizenship through documents such as a birth certificate or a U.S. passport.

Medicaid beneficiaries have to renew their benefits every year.

"This procedure keeps access to health care to those who need it the most and ensures that the state is being a good steward of the taxpayer dollar,'' said Shane Hix, a spokesman for Perdue.

But consumer advocates say the new rules harm children who are U.S.-born to immigrant parents. Those children are citizens and are entitled to Medicaid.

Lack of documents

Susy Martorell, a DeKalb County social worker who helps sign up families for Medicaid, said many immigrant and other families don't have the document requirements for coverage, include a photo ID and a birth certificate for their child.

When parents can't get Medicaid coverage, she said, "Their child gets sicker and sicker, and they wind up in the emergency room.'' Immigrant parents, Martorell said, "are more scared than ever of immigration raids — of being picked up and deported.'' Those parents are intimidated into not signing up their U.S.-born children for Medicaid, she said.

"I have worked more than 20 years in social work, and there's very little fraud in families seeking benefits to which they're not entitled,'' Martorell said. State officials said they were unable to give numbers of cases of fraud within the 69,635 drop.

Special-needs changed

Community Health said the 69,635 decrease in Medicaid includes:

About 10,000 Katrina evacuees who have not renewed their membership.

About 1,000 had been erroneously double-counted.

An undetermined number of other beneficiaries could not be found at their listed addresses.

Among children losing coverage this year are at least 596 special-needs children covered under the "Katie Beckett'' waiver. The department has dropped hundreds of families from the program for disabled and medically fragile children after it tightened its eligibility rules in 2004 to match the federal government's.

State officials say most of these children have private insurance coverage.

A former Community Health communications manager, Martin Smith, who has a son with Down syndrome, said ''the state is trying to disenroll people by putting up extraordinary paperwork burdens'' and by adding requirements for medical problems eligible for Katie Beckett coverage.

Smith, whose child, Broker, was denied that coverage, said, "This is about saving money. ... I want the state to invest in children like Broker.''

Medicaid is also limiting speech, occupational and physical therapy services for children approved for Katie Beckett, parents say.

Medicaid had a decrease of 2,827 in the number of illegal immigrants getting coverage for emergency medical treatment.

The state in January terminated Medicaid benefits for illegal immigrants with chronic medical needs, including children requiring dialysis, and prenatal care for women with high-risk pregnancies. The state says it has made this change, too, to comply with federal rules.