Only citizens to get Medicaid
By SEAN MUSSENDEN
Media General News Service
Saturday, July 1, 2006


WASHINGTON - A new law designed to keep illegal immigrants off Medicaid will force all applicants to prove citizenship before enrolling in the taxpayer-funded health care program.

Backers say the law, effective today, will ensure that scarce health care dollars are reserved for poor citizens.

But advocates for the poor fear the law could backfire. They worry it will deprive millions of low-income, legal citizens needed medical coverage while having little impact on undocumented immigrants. Government studies suggest a tiny percentage of illegal immigrants fraudulently enroll in Medicaid.

Except for some emergency coverage, only U.S. citizens are eligible for Medicaid, the health program for more than 50 million poor people that is funded by state and federal tax dollars.

Until today, though, all but four states allowed applicants simply to sign a form saying they were citizens.

Now, people who apply for Medicaid or re-enroll will have to show a U.S. birth certificate, a passport or other proof of citizenship. Advocates for the poor say millions of legal Medicaid recipients lack such proof.

The abuse of taxpayer-funded programs by undocumented workers has become a hot-button issue in the fight over the nation's immigration laws.

"This rule is wrapped up in this immigration hysteria," said Steven Weinman, vice president of Collier Health Services, which owns a health clinic serving thousands of migrant farmworkers in Immokalee, Fla.

"They're requiring proof for something that has been shown over and over again not to be a problem. If they had a huge number of undocumented people getting Medicaid, then I could see the need for this," he said.

But Rep. Charlie Norwood, R-Ga., who was instrumental in passing the law earlier this year, cited recent budget cuts that have forced many states to trim Medicaid programs.

"Every dollar taken from Medicaid by an illegal immigrant is a dollar taken from a poor American citizen," Norwood's spokesman John Stone said.

It's unclear exactly how many illegal immigrants are fraudulently enrolled in Medicaid, but the few available estimates suggest it's only a miniscule percentage.

A 2006 study by the Congressional Budget Office estimated that of the more than 50 million people receiving Medicaid, 35,000 are illegal immigrants getting coverage illegally -- less than one-tenth of 1 percent. An estimated 12 million illegal immigrants live in the country.

Removing an estimated 35,000 illegal immigrants from the Medicaid rolls by 2015 would save $735 million, according to congressional researchers. That was justification for the change, Stone said, adding that Norwood believes the true number of illegal immigrants on Medicaid to be much higher.

A review by the federal Department of Health and Human Services also found "little evidence" that non-citizens were using Medicaid illegally but it nonetheless recommended the rule change.

Eddie Wooten helps enroll poor people in Medicaid in Yadkin County, N.C., which has seen a surge in Hispanic immigrants in recent years. Wooten, the county's social services director, said that many illegal immigrants enroll their children who were born here -- and thus are legal citizens. But few of the parents sign up themselves.

"Most people who are illegal are smart enough to know not to apply for themselves because it could get them in trouble later down the line," if they apply for legal residency, he said.

The lack of health insurance doesn't keep illegal immigrants from the doctor, though it makes regular checkups rare, immigrant health specialists said.

Because many immigrants work long hours for low pay in potentially hazardous industries like construction or around pesticides in farm fields, illnesses and injuries are common, immigrant advocates said.

At Catholic Social Services in Asheville, N.C., Jerry Tudela helps immigrants with legal problems. He said most illegal immigrants turn first to home-remedies, then go to free or reduced-price medical clinics that are common in areas with large immigrant populations. These patients pay cash for health services, if required, he said.

If their health condition is serious, they'll go to the emergency room. Under Medicaid's rules, the program generally covers life-threatening injuries and illnesses for illegal immigrants.

"We tell them not to apply for government benefits, and I don't think too many do" for preventative care, Tudela said. "They think if the government has their information, they'll get in trouble."

In Immokalee, a farming town on Florida's Southwestern tip, more than 20,000 migrant farmworkers -- both legal residents and illegal immigrants -- are seen every year at a low-cost medical clinic run by Collier Health Services.

For legal farmworkers with Medicaid, the new rules will "add another layer of complexity to an already difficult process," said Weinman. Some could lose coverage because they lack proper documentation, he said.

Advocacy groups for the poor, some state medicaid directors, and civil rights groups also worry that the new requirements could hurt poor citizens.

Lawsuits challenging the law were filed this week in Washington and Chicago. A Medicaid spokesperson did not return three phone calls this week seeking comment on the law.

Leighton Ku, a health policy analyst at the Center on Budget and Policy Priorities, a Washington group that studies poverty programs, estimated that between 3 million and 5 million citizens could have coverage delayed or blocked because they lack documentation.

A spokeswoman for Virginia's Medicaid program said the state is concerned the new regulations might dissuade eligible people from applying.

Of particular concern to some civil rights groups are older blacks born in the South in the first half of the 20th Century. Because discrimination kept their mothers out of hospitals, many were never issued birth certificates.

"Lots of people who are U.S.-born citizens don't carry around something that says 'I'm a native-born citizen,'" Ku said. "Poor people who are on Medicaid don't usually plan to go to Europe, so they don't have a passport. And if you had a birth certificate at one time, there's a good chance you've lost it."

Stone, Norwood's spokesman, said those fears are overblown. The law allows current Medicaid recipients to retain their coverage while they seek the necessary documentation, he noted. And, in rare circumstances where documents cannot be found, the law allows for a written affidavit, he said.

Sean Mussenden is a national correspondent in Media General's Washington Bureau.

This story can be found at: http://www.manassasjm.com/servlet/Satel ... 1369&path=

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