Federal Proof-of-Citizenship Rules Lead to Enrollment Declines in Six States’ Medicaid Programs, Mostly Affect U.S. Citizens, Study Finds
Medicaid enrollment decreased in six state programs after CMS implemented a law that requires beneficiaries and applicants to provide proof of U.S. citizenship to receive care through the program, according to a report released on Friday by the Center on Budget and Policy Priorities, CQ HealthBeat reports (Reichard, CQ HealthBeat, 2/2). Under the law, which took effect in July 2006, individuals who seek coverage through Medicaid must provide proof of citizenship, such as a birth certificate, passport or other form of identification. For the report, CBPP examined Medicaid programs in Iowa, Kansas, Louisiana, New Hampshire, Virginia and Wisconsin (AP/Boston Herald, 2/2). The report found that "data strongly suggest that the new rule is a major factor behind the decline" in Medicaid beneficiaries in the six programs. According to the report, eligible Medicaid beneficiaries and applicants often experience delays in efforts to obtain identification that can leave them without access to care for months. Between 18,000 and 20,000 Kansas residents eligible for Medicaid lost coverage after CMS implemented the law, and Iowa "sustained the largest decrease" in Medicaid enrollment in the past five years between July 2006 and September 2006, according to the report. The number of children enrolled in the Louisiana Medicaid program decreased by more than 7,500 in September 2006 and October 2006, "despite a vigorous back-to-school outreach effort" to increase enrollment among children, the report found. The report also found that the number of children enrolled in the Virginia Medicaid program decreased by 12,000 from July 2006 through November 2006, despite an increase in enrollment in SCHIP over the same period. In Wisconsin, "14,000 Medicaid-eligible individuals were either denied Medicaid or lost coverage between August and December as a result of the new rule," the report found (CQ HealthBeat, 2/2).
Donna Cohen Ross, author of the report, said, "This new law has reversed the course that states have been pursuing quite successfully for the past 10 years ... of making Medicaid enrollment simpler and more streamlined," adding, "The people bearing the brunt are U.S. citizens who are otherwise eligible for the program" (AP/Boston Herald, 2/2). Ruth Kennedy, deputy director of the Louisiana Medicaid program, said the law has doubled the amount of time required to enroll state residents in the program (Moller, New Orleans Times-Picayune, 2/3). CMS spokesperson Mary Kahn, said that "a snapshot of the first three months of a new and complicated eligibility rule is just not a reliable measure of the long-term impact of that new rule" (CQ HealthBeat, 2/2).