Medicaid citizenship rules costing health centers

Facilities are losing Medicaid patients and their funding, a survey finds.

By Doug Trapp, AMNews staff. June 18, 2007.

Washington -- Medicaid documentation requirements are straining federally qualified health centers by decreasing their Medicaid populations -- their largest source of funding.

Medicaid identity and citizenship requirements that began July 1, 2006, have cost health centers $28 million to $85 million and 2.2% to 6.7% of their 4.8 million Medicaid enrollees, found an online survey released last month by the George Washington University School of Public Health and Health Services. Responses came in from 139 of the 300 federally qualified health centers surveyed. There are 952 such facilities in the U.S.

The report is the first attempt to examine the national effects of the rules, which require Medicaid applicants to prove their citizenship using original documents -- birth certificates, driver's licenses, passports and other government-issued identification -- or certified copies.

Critics have said the rules, in an attempt to keep undocumented immigrants off Medicaid, place an unreasonable burden on the elderly, foster children and the physically or mentally disabled because they have difficulty accessing such documents. Previously, applicants in most states were able to attest to their citizenship under penalty of perjury.

"We think these findings underscore the need to fundamentally rethink both the statute and the regulations," said Sara Rosenbaum, one of the report's authors and professor and chair of the George Washington University Dept. of Health Policy.