Thread: US rule demands proof of citizenship for healthcare

US rule demands proof of citizenship for healthcare
Law could hurt the state's poorest

By Scott Helman, Globe Staff | April 11, 2006

Almost all of the state's poorest residents will have to show proof of US citizenship to continue getting medical care by July 1, under a little-noticed federal law that could endanger coverage for many, as Massachusetts is trying to expand access to healthcare.

Born out of ongoing efforts in Washington to clamp down on illegal immigration, the new federal requirement compels anyone seeking Medicaid coverage to provide a birth certificate, a passport, or another form of identification in order to sign up for benefits or renew them.

No such proof is required now.

The requirement was tucked into the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year.

The measure was part of an effort to limit the skyrocketing growth of federal entitlement programs. It has surfaced as Massachusetts begins to implement its sweeping healthcare plan, which aims to bring health coverage to almost all of the state's uninsured, in part by enrolling those in Medicaid who are eligible but who have not signed up.


Healthcare specialists voiced fear that because many Medicaid recipients -- including the homeless and the mentally disabled -- won't be able to easily produce documentation of their citizenship, they will have difficultly receiving care at community health centers, hospitals, or anywhere else.

''So we've got people in nursing homes, people in the [state Department of Mental Retardation] institutions, we've got the homeless, we've got the . . . mentally ill who now will have to come up with some verification to prove that they're citizens," said Victoria Pulos, health law attorney at the Massachusetts Law Reform Institute. ''It's ironic that this is happening in the state where part of the health reform plan is to make sure that everyone who's eligible for Medicaid is enrolled."

The new federal requirement, which all states have to comply with, would apply to the vast majority of the more than 1 million people on MassHealth, the Massachusetts Medicaid program.

The intent is to prevent undocumented immigrants from posing as citizens and taking advantage of taxpayer-funded healthcare benefits that are afforded only to legal residents. (Under federal law, undocumented immigrants can receive only emergency Medicaid care; Massachusetts has 40,000 on such a program, which is called MassHealth Limited.)

Less than three months before the new citizenship requirement takes effect, though, Massachusetts and other states are waiting for guidance from the federal government on how it will work.

Mary Kahn, a spokeswoman for the federal Centers for Medicare & Medicaid Services, said that the agency is writing the regulations, but that there is no indication of a delay.

Massachusetts already compels Medicaid recipients to verify their incomes, usually through W-2 forms, to ensure that the figure is low enough to qualify for the program. The state Medicaid director, Beth Waldman, played down the difficulty of adding another requirement.

This shouldn't take away from people's access to healthcare," Waldman said. ''All you need to do is show that you're a citizen."

Waldman said that many of the state's 1,033,000 MassHealth recipients are not likely to have trouble proving citizenship, because they have already had to do so in registering with some other federal program, such as Social Security. (About 478,000 MassHealth members, for example, also get Medicare, Social Security, or welfare benefits, the state says.)

Some healthcare advocates, though, described the new rules as onerous on community health centers and other healthcare providers, but more so on Medicaid recipients, many of whom, they said, may not continue getting care if they cannot provide the paperwork or may have to wait to get treatment until they can locate the right documents.

''We're in the business of trying to make central Dorchester and parts of Mattapan a healthier place," said Bill Walczak, chief executive officer of Dorchester's Codman Square Health Center. ''We didn't create the healthcare centers to become citizenship enforcement centers."

The provision was added to the Deficit Reduction Act by two Republican representatives from Georgia, Charles Norwood and Nathan Deal, who have been outspoken against illegal immigration. Bush signed the legislation two months ago, saying, ''The bill I sign today restrains spending for entitlement programs while ensuring that Americans who rely on Medicare and Medicaid continue to get the care they need."


Chris Riley, Deal's chief of staff, said yesterday that the citizenship provision was simply about ''enforcing the law."

''The intent was to verify that US citizens are getting Medicaid," Riley said.

Norwood issued a statement in February saying, ''After years of listening to 'advocates' whine about compassion for those who intentionally break our laws for financial gain, I'm glad to see us finally showing some compassion for our own poor and sick who abide by the law."

State Representative Marie J. Parente, a Milford Democrat who speaks often about restricting illegal immigration, said she agreed with Norwood's statement. Parente said she was at an event in Peabody yesterday at which someone asked her about healthcare for illegal immigrants.

''I said, 'Why don't you have the same compassion for the American people who don't have a good healthcare plan?' " said Parente, who hosted a meeting on immigration last week at the State House that she said drew more than 1,000 people.

The Center on Budget and Policy Priorities in Washington, D.C., issued a report this year saying that the rule would affect nearly 50 million people nationwide.

It would, the report said, ''almost certainly create significant enrollment barriers for millions of low-income citizens who meet all Medicaid eligibility requirements."

An evaluation of the Medicaid program by the inspector general of the US Department of Health and Human Services in July 2005 recommended the agency strengthen quality control to prevent abuse by noncitizens.

It did not, however, recommend requiring recipients to provide proof of citizenship.

Healthcare providers said it was too early to know how the federal requirement would affect Massachusetts, but they say they would always treat people who need care, no matter their ability to pay nor their documentation. They said it could, however, create complications for them in qualifying for federal reimbursement.

''We know that this will create some potential problems for folks in traditional Medicaid programs," said a Massachusetts Hospital Association spokesman, Paul Wingle. ''What this comes down to for hospitals is really not . . . whether folks get urgently needed care. It comes down to whether or not that care will be reimbursed."

Scott Helman can be reached at shelman@globe.com.
© Copyright 2006 Globe Newspaper Company.





Message Board YOUR VIEW: Let illegal immigrants stay?

had Congress and the President DONE THEIR JOB, and repelled invasion, the citizens wouldn't have to PROVE they belong here

please send this to your local television station -- this should get some sympathizers on board

added to homepage

https://www.alipac.us/article1154.html

Some healthcare advocates, though, described the new rules as onerous on community health centers and other healthcare providers, but more so on Medicaid recipients, many of whom, they said, may not continue getting care if they cannot provide the paperwork or may have to wait to get treatment until they can locate the right documents.

Everyone has a certain amount of personal responsibility to keep up their important documents, such as a birth certificate. I think the people that are complaining are mostly apologists for the illegals and the doctors/hospitals are concerned that they won't be able to get reimbursed by the government for the free care they have to give to illegals and the indigent.

A copy of your birth certificate costs $5, even the poor can afford that if they want to receive benefits.

The problem is that the illegals go to the emergency room for "colds" and get treated. A lot of hospitals send people through the whole triage system to avoid lawsuits. You and I don't pay, they will bankrupt you or you will spend the rest of your life trying to get out of debt.

Its great they are doing this in Boston. this needs to spread to all the cities and states of the nation - how do we spread this example through the right people?

can we start a action plan where OUR ALIPAC activists for each state, s\tale this story to their congressmen and senators and say this is a great example of what we need?

i am happy to start this rolling...

Here's what i sent to my senators and Governor..

Dear Senator I would like to propose an idea whereby we could stand a better chance to save our hospitals under the crushing demands placed on them by ILLEGAL ALIENS. Can we look at what Boston is doing here as in the article below?

That's right it is good that they are using it. They are enforcing the law as it is supposed to be. now if they would start enforcing all immigration laws, we wouldnt be in the mess that we are.

At various times in my life I have had to apply for aid such as food stamps or medicaid. In the 4 different states that I lived in I had to supply my birth certificate and those of my children. This is going back to 1980. This is nothing new. No birth certificate, no benefits. Somebody out there is just trying to use this as an excuse of giving benefits for illegals. They, of course, should not have birth certificates if they weren't born here. Their American born children can still collect benefits though.

Originally Posted by rainbowblue

This is nothing new. No birth certificate, no benefits. Somebody out there is just trying to use this as an excuse of giving benefits for illegals. They, of course, should not have birth certificates if they weren't born here. Their American born children can still collect benefits though.

It has its downside:

There are many American citizens who might not be able to obtain birth certificates: the elderly.
There should be some other available form or method of proof for them.

Some might be able to provide a copy of US Census records, but not everyone can always be located in census records. In order to collect SS checks, my mother provided a copy of Census records and an affadavit from someone who had known her for twenty years.
There are exeptions to the birth certificate requirement. Every American citizen does not have birth certificates.

As far as illegals, many of them have phony documents, including birth certificates.

As far as the American born children of illegals, I feel that something needs to be doen in this country to redefine or clarify the 14th amendment because I think it's being abused. Almost 400,000 born each year to illegals that 'qualify' for Medicaid.