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Medicaid Users May Lose Benefits

By Trip Jennings
Journal Capitol Bureau
    SANTA FE— A little-known federal rule requiring Medicaid recipients to prove U.S. citizenship with birth certificates or passports might soon cost eligible New Mexicans health care, lawmakers were told Wednesday.
    As of July 1, under a proposal President Bush signed into law this February, New Mexico's roughly 410,000 Medicaid recipients— and people hoping to qualify for the program— will be restricted in the type of documents they can use as proof of citizenship to qualify for the federal low-income health care program.
    And that has state officials worried that the new rules— which also require officials to get proof of citizenship rather than merely empowering them to ask for it— might well undermine recent efforts to enroll more of New Mexico's uninsured children in Medicaid.
    "It could unfairly reduce enrollment to people who are citizens, who we have the funding to provide care for," Pamela Hyde, the state's human services secretary, told state lawmakers on the Legislative Finance Committee on Wednesday.
    Hyde did not have an estimate of eligible Medicaid recipients likely to be affected by the new law. Nearly one in every five New Mexicans receives Medicaid, which the federal government and the states fund jointly.
    But Hyde and others predict low-income children, elders on New Mexico's tribal lands and the mentally disabled— U.S. citizens who don't have or cannot locate the documents required under the new rules— will be among the first casualties.
    "A lot of Native American children do not have a birth certificate," said Bill Jordan, deputy director for policy at New Mexico Voices for Children, an organization that has worked in recent years to enroll Native American children.
    "It is another barrier that is intended to reduce the enrollment in Medicaid," Jordan said. "As you increase the hassle factor, you decrease participation."
    The proposed rules, which are still under review at the federal Centers of Medicare and Medicaid Services, are creating a stir, not only in New Mexico but nationwide, as states attempt to figure out how to notify the affected populations of the new requirements prior to July 1, officials said.
    A constant refrain from state Medicaid directors and state human service secretaries from across the country has been how do you enroll U.S. citizens who don't have birth certificates or passports, said Elaine Ryan, deputy executive director of Washington-based American Public Human Services Association.
    "It's confounding really," she said. "Frankly, there are no new funds in this legislation to help states administer this."
    States have little time to set up procedures to accept documents— birth certificates and passports— approved under the new rules, she added.
    There always has been a requirement that Medicaid recipients be U.S. citizens. But the proposed new rules restrict what documents count as proof of citizenship, said Katie Falls, state deputy human services secretary under Hyde.
    Currently, New Mexico can use tribal or church records and— in some cases, affidavits signed by people declaring under penalty of law they are U.S. citizens— to prove a person's citizenship, officials said.
    Not anymore.
    "An applicant or recipient who does not cooperate with the requirement to present documentary evidence of citizenship may be denied eligibility or terminated," states a draft letter from the Centers of Medicare and Medicaid Services to state Medicaid directors.
    "It's not enough to say you are a citizen any more," Falls said, paraphrasing the letter. "They must prove it."
    Another possible effect state officials said may be longer lines at offices as Medicaid recipients come in person to prove they are citizens.
Copyright 2006 Albuquerque Journal

E-MAIL writer Trip Jennings