Individuals seeking care through Medicaid beginning on July 1 will be required under federal law to show proof of U.S. citizenship -- such as a birth certificate, passport or another form of identification -- the Boston Globe reports. The requirement was included in the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year. The provision's intent is to prevent undocumented immigrants from claiming to be citizens in order to receive benefits only provided to legal residents, according to the Globe. Under federal law, undocumented immigrants can receive only emergency care through Medicaid. Some health care specialists are concerned that with the new citizenship requirements, many Medicaid beneficiaries, including those who are mentally disabled or homeless, will not be able to produce documentation and will have difficulty receiving health services.
The Center on Budget and Policy Priorities earlier this year issued a report saying the law will affect almost 50 million people and will "almost certainly create significant enrollment barriers for millions of low-income citizens who meet all Medicaid eligibility requirements." Massachusetts Medicaid Director Beth Waldman said, "This shouldn't take away from people's access to health care. All you need to do is show that you're a citizen." She noted that many Massachusetts Medicaid beneficiaries already must show proof of citizenship to register for other federal programs. Health care providers said they will continue to treat patients who cannot prove their citizenship, but the law could make it more difficult for providers to receive federal reimbursements. Another concern is that states have not been notified about how the law will be enforced, according to the Globe. CMS spokesperson Mary Kahn said the agency is writing the regulations (Helman, Boston Globe, 4/11).
Emergency Care Law
In related news, a group of Oregon hospitals began asking emergency department patients to supply their places of birth in order to determine how many undocumented patients they were treating and thus their level of reimbursement from the federal government, the Oregonian reports. Under federal law, most hospitals must treat anyone who is seeking emergency care or who is in active labor. Section 1011 in the 2003 Medicare law gives U.S. hospitals $1 billion over four years to care for undocumented immigrants. The provision also instructs providers not to ask patients directly about their citizenship status. Legacy Health System's four Oregon hospitals decided to ask for places of birth because many officials "are loath to ask the probing questions needed to determine whether a patient is in the United States illegally," the Oregonian reports (O'Neill, Oregonian, 4/10).