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Limiting access: Will Medicaid fail its citizenship test?

Doctors worry that a law aimed at preventing illegal immigrants from getting program benefits instead will hurt access for lawful residents.

By Elaine Monaghan, amednews staff. Aug. 7, 2006.

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The federal government last month eased the new requirement that Medicaid recipients prove their U.S. citizenship. But the changes won't help everyone, say doctors who treat these patients.

Take David Bell, for example.

About 65 years old, Bell was born into 1940s Alabama. The son of sharecroppers, he says he was one of about 16 children in his family. His mother died when he was small. Like his siblings, with whom he has no contact, he was not born in a hospital. He has no birth certificate.

"We grew everything -- cotton, corn, peanuts, cucumbers," the soft-spoken man said in an interview in the waiting room of the medical clinic at Bread for the City, a community health center in Washington, D.C., that serves many low-income Medicaid recipients. "By being so many of us, we went hungry most of our lives."

The law, which took effect July 1, mandates that individuals seeking care through Medicaid show proof of U.S. citizenship, such as a birth certificate, passport or other acceptable form of identification. The measure, signed by President Bush in February as part of the Deficit Reduction Act, is supposed to prevent illegal immigrants from abusing the system.

But many doctors argued that the real victims would be millions of impoverished Americans, particularly elderly black patients, and that the law was unnecessary.

"People are not trying to get around the system," said Randi Abramson, MD, the medical director at Bread for the City, which provides a variety of services to the needy, including food. "In reality, most people tell the truth." Her assessment of the law: "It's built on fear and based on nothing."