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Wednesday, June 21, 2006 

Show Us Your Papers!

Beginning next month, all US citizens applying for Medicaid or renewing their Medicaid eligibility will have to prove their citizenship by presenting a U.S. passport or the combination of a U.S. birth certificate and an identification document. Individuals who cannot do so will be denied health services financed with federal Medicaid funds. It seems Dudya and Congress pulled another fast one. According to the NY Times:
The Bush administration plans ... to issue strict standards requiring more than 50 million low-income people on Medicaid to prove they are United States citizens by showing passports or birth certificates and a limited number of other documents.

The requirements, which take effect July 1, carry out a law signed by President Bush on Feb. 8 [Public Law No. 109-171,§ 6037].

... The purpose of the law was to conserve federal money for citizens, reducing the need for states to cut Medicaid benefits or limit eligibility.
More than 50 million Medicaid recipients will soon have to produce birth certificates, passports or other documents to prove that they are United States citizens, and everyone who applies for coverage after June 30 will have to show similar documents under a new federal law.

The lies given by the Congressional Budget Office. They claim that 35,000 people will lose coverage by 2015. Most of them will be illegal immigrants, but some will be citizens unable to produce the necessary documents.

However, that is a plain out right lie. On June 9 the Centers for Medicare & Medicaid Services (CMS) issued a guidance to state Medicaid agencies explaining the requirement and what individuals and states must do to comply with it. The guidance makes harder on US citizens and state Medicaid agencies than is required by the DRA or needed to ensure that US citizens are in fact US citizens.

Under the terms of the guidance:
  • US citizens applying for or renewing their Medicaid coverage must produce passports or birth certificates to prove their citizenship unless they can show these documents do not exist or cannot be obtained within a reasonable period of time.
  • All documents provided to meet the requirement must either be originals or copies certified by the issuing agency.
  • US citizens who apply for Medicaid and meet all eligibility criteria cannot receive coverage for needed health or long-term care services until they have produced the required documents proving that they are citizens. The guidance prohibits states from making coverage available while the applicant attempts to obtain a passport or birth certificate. Delaying coverage for applicants in this way is a significant departure from the draft guidance that HHS circulated in May. The draft guidance would have allowed US citizens who meet all other eligibility requirements to receive Medicaid coverage while they obtain the documents that prove their citizenship. By contrast, under the final guidance, low-income children, parents, seniors and people with disabilities who have applied for passports, copies of their birth certificates, or other documents will be denied coverage for health care services while they wait for government agencies to provide these documents.
  • The documentation requirement will even apply to seniors and people with physical or mental disabilities who are Medicare beneficiaries, as well as to seniors and people with disabilities who receive SSI benefits, all of whom have already had their citizenship verified by the Social Security Administration. Many of these people may now be in a physical or mental state that makes it difficult, if not impossible, for them to produce these documents (and in some cases, even to comprehend what they are being asked to do).
  • State Medicaid agencies will have to obtain documents showing that US citizen children in foster care are citizens, even though state child welfare agencies have already verified that fact in determining these children's eligibility for federal foster care payments.
These provisions will result in delays, outright denials, and loss of coverage for many US citizens applying for Medicaid. US citizens who cannot provide "primary" documents to meet the documentation requirement must provide proof both of citizenship and of their personal identity. Using birth certificates, along with several other documents such as - final adoption decrees and official records of military service, will be considered as "secondary evidence" of citizenship.

The guidelines list four categories of documents that can be used as evidence of citizenship:
  • 1st category: US passport or a certificate of naturalization;
  • 2nd category: state and local birth certificates and State Department documents issued to children born abroad to United States citizens;
  • 3rd category: nongovernment documents - medical records from doctors, hospitals and clinics, nursing home admission papers, and records from life and health insurance companies; and
  • 4th category: affidavits, which can be used "only in rare circumstances when the state is unable to secure evidence of citizenship" from other sources.
Documents that are considered acceptable of proof of identity, such as - driver's license; school identification card; include a picture of the individual, however, many people with disabilities do not have these documents and CMS does not make any provisions to help people with disabilities prove their identity.

According to HealthLawProf Blog the new standards will create an additional hardship and possible loss of benefits to millions of children, older Americans and poor people born at home in rural areas who never received birth certificates. HealthLawProf also explains:
Federal policy may be to deny health care benefits to undocumented immigrants, but it obviously doesn't go so far as to require (or even permit) the denial of health care services (emergency services, at any rate) to undocument immigrants. EMTALA requires Medicare-certified hospitals to provide a medically appropriate screening for patients who come to their ER's and to attempt to stabilize any emergency condition found to exist, and this requirement applies (as it should) regardless of the patient's citizenship status. Tightening up Medicaid eligibility rules may (or may not) make some kind sense as a matter of immigration policy, but as a health care policy it only makes a bad situation worse -- and not only for hospitals.
Examples of those who are at risk of having their Medicaid coverage terminated, denied, or delayed are:
  • An elderly parent who is stricken with Alzheimer's and resides in an assisted living residence can lose Medicaid coverage which happens to pays for their care because their birth certificate cannot be located or no longer has a driver's license.
  • A child of an incarerated single mother may not receive Medicaid coverage for the health services because a certified birth certificate cannot be located.
  • A low-income woman who is just diagnosed with breast cancer and would qualifies for Medicaid, treatment could be delayed for a number of weeks or months because she is forced to wait for a certified copy of her birth certificate.
  • An elderly African American woman who was never issued a birth certificate (many elderly African Americans were born at home and never received a birth certificate because their parents did not have access to a hospital due to racial discrimination, especially if they were born in the South in the early decades of the last century) and who has no living family members who could attest to her birth in the United States may lose Medicaid coverage.
  • Native Americans who could lose thier coverage because "certificates of Indian blood" and other forms of tribal identification are not considered proper identifications.
Here is the irony of it all, in a quest by the Rethugs to screw the undocumented, they ended up screwing its own citizens. Since emergency health care benefits to undocumented immigrants can not be denied all they did was create a silly health care policy that only made things worse. They are so blinded by their hate, they do not see how they are clearly destroying lives and families and the very fabric of this country they claim to care about.

If you do not have insurance, you can now kiss your health care good bye.

Considering that I do get visitors from Congress, I HOPE YOU ARE READING THIS!!!!

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