[LINK] The US backfire re identity documentation for medical payment system
jwhit at melbpc.org.au
Tue Mar 13 09:11:32 AEDT 2007
Given the Link interest in the Access ID card and
Rick's story, here's what's happening in the US
re their demand for identity documents to be
'eligible' for health benefits from the public
purse. If it happens in the US, count on it
happening here with the Access ID card. Lots of
similarities re providing original documents. I
can't imagine our Australian bureaucrats are any
better at this sort of thing, and with so many
immigrants here as well, you gotta wonder what
the effect will be here. ACOSS needs to be made aware of this situation.
March 12, 2007
Citizens Who Lack Papers Lose Medicaid
By ROBERT PEAR
WASHINGTON, March 11 A new federal rule
intended to keep illegal immigrants from
receiving Medicaid has instead shut out tens of
thousands of United States citizens who have had
difficulty complying with requirements to show
birth certificates and other documents proving
their citizenship, state officials say.
Florida, Iowa, Kansas, Louisiana, New Mexico,
Ohio and Virginia have all reported declines in
enrollment and traced them to the new federal
requirement, which comes just as state officials
around the country are striving to expand
coverage through Medicaid and other means.
Under a 2006 federal law, the Deficit Reduction
Act, most people who say they are United States
citizens and want Medicaid must provide
satisfactory documentary evidence of
citizenship, which could include a passport or
the combination of a birth certificate and a drivers license.
Some state officials say the Bush administration
went beyond the law in some ways, for example, by
requiring people to submit original documents or
copies certified by the issuing agency.
The largest adverse effect of this policy has
been on people who are American citizens, said
Kevin W. Concannon, director of the Department of
Human Services in Iowa, where the number of
Medicaid recipients dropped by 5,700 in the
second half of 2006, to 92,880, after rising for
five years. We have not turned up many
undocumented immigrants receiving Medicaid in
Waterloo, Dubuque or anywhere else in Iowa, Mr. Concannon said.
Jeff Nelligan, a spokesman for the federal
Centers for Medicare and Medicaid Services, said
the new rule was intended to ensure that
Medicaid beneficiaries are citizens without
imposing undue burdens on them or on states. We
are not aware of any data that shows there are
significant barriers to enrollment, he said.
But if states are experiencing difficulties,
they should bring them to our attention.
In Florida, the number of children on Medicaid
declined by 63,000, to 1.2 million, from July 2006 to January of this year.
Weve seen an increase in the number of people
who dont qualify for Medicaid because they
cannot produce proof of citizenship, said Albert
A. Zimmerman, a spokesman for the Florida
Department of Children and Families. Nearly all
of these people are American citizens.
Since Ohio began enforcing the document
requirement in September, the number of children
and parents on Medicaid has declined by 39,000,
to 1.3 million, and state officials attribute
most of the decline to the new requirement. Jon
Allen, a spokesman for the Ohio Department of Job
and Family Services, said the state had not seen
a drop of that magnitude in 10 years.
The numbers alone do not prove that the decline
in enrollment was caused by the new federal
policy. But state officials see a
cause-and-effect relationship. They say the
decline began soon after they started enforcing
the new rule. Moreover, they say, they have not
seen a decline in enrollment among people who are
exempt from the documentation requirement for
example, people who have qualified for Medicare
and are also eligible for Medicaid.
Wisconsin keeps detailed records listing reasons
for the denial or termination of benefits. From
August 2006 to February of this year, we
terminated benefits for an average of 868 people
a month for failure to document citizenship or
identity, said James D. Jones, the eligibility
director of the Medicaid program in Wisconsin.
More than 600 of those actions were for failure
to prove identity. In the same period, Mr. Jones
said, the state denied an average of 1,758
applications a month for failure to document
citizenship or identity. In 1,100 of those cases,
applicants did not provide acceptable proof of identity.
Congress wanted to crack down on illegal
immigrants who got Medicaid benefits by
pretending to be U.S. citizens, Mr. Jones said.
But the law is hurting U.S. citizens, throwing
up roadblocks to people who need care, at a time
when we in Wisconsin are trying to increase access to health care.
Medicaid officials across the country report that
some pregnant women are going without prenatal
care and some parents are postponing checkups for
their children while they hunt down birth certificates and other documents.
[take note: it's the most needy who are missing out]
Rhiannon M. Noth, 28, of Cincinnati applied for
Medicaid in early December. When her 3-year-old
son, Landen, had heart surgery on Feb. 22, she
said, he did not have any insurance because she
had been unable to obtain the necessary
documents. For the same reason, she said, she
paid out of pocket for his medications, and eye
surgery was delayed for her 2-year-old daughter, Adrianna.
The children eventually got Medicaid, but the
process took 78 days, rather than the 30 specified in Ohio Medicaid rules.
Dr. Martin C. Michaels, a pediatrician in Dalton,
Ga., who has been monitoring effects of the
federal rule, said: Georgia now has 100,000
newly uninsured U.S. citizen children of
low-income families. Many of these children have
missed immunizations and preventive health
visits. And they have been admitted to hospitals
and intensive care units for conditions that
normally would have been treated in a doctors office.
[NOTE: more impact on over stretched emergency units]
Dr. Michaels, who is president of the Georgia
chapter of the American Academy of Pediatrics,
said that some children with asthma had lost
their Medicaid coverage and could not afford the
medications they had been taking daily to prevent
wheezing. Some of these children had asthma
attacks and had to be admitted to hospitals, he said.
In Kansas, R. Andrew Allison, the state Medicaid
director, said: The federal requirement has had
a tremendous impact. Many kids have lost coverage
or have not been able to obtain coverage. Since
the new rule took effect in July, enrollment in
Kansas has declined by 20,000 people, to 245,000,
and three-fourths of the people dropped from the rolls were children.
Megan J. Ingmire, a spokeswoman for the Kansas
Health Policy Authority, which runs the state
Medicaid program, said the waiting time for
applicants had increased because of a huge
backlog of applications. Applicants need more
time to collect the necessary documents, and it
takes us longer to review the applications, Ms. Ingmire said.
[NOTE: backlog and that's not with issuing any
sort of card! I wonder how the 12 minute
processing time the Howard govt has planned for
Access ID card signup will avoid similar backlogs]
The principal authors of the 2006 law were
Representatives Charlie Norwood and Nathan Deal,
both Georgia Republicans. Mr. Norwood died last month.
Chris Riley, the chief of staff for Mr. Deal,
said the new requirement did encounter some
bumps in the road last year. But, he said, Mr.
Deal believes that the requirement has saved
taxpayers money. The congressman will
vigorously fight repeal of that provision and
will, in fact, try to extend it to the Childrens
Health Insurance Program, Mr. Riley said. He
added that the rule could be applied flexibly so
it did not cause hardship for citizens.
[note; they like function creep too]
In general, Medicaid is available only to United
States citizens and certain qualified aliens.
Until 2006, states had some discretion in
deciding how to verify citizenship. Applicants
had to declare in writing, under penalty of
perjury, whether they were citizens. Most states
required documents, like birth certificates, only
if other evidence suggested that a person was
falsely claiming to be a United States citizen.
In Virginia, health insurance for children has
been a top priority for state officials, and the
number of children on Medicaid increased steadily
for several years. But since July, the number has
declined by 13,300, to 373,800, according to
Cindi B. Jones, chief deputy director of the Virginia Medicaid program.
The federal rule closed the door on our ability
to enroll people over the telephone and the
Internet, wiping out a full year of progress in covering kids, Ms. Jones said.
State and local agencies have adopted new
procedures to handle and copy valuable documents.
J. Ruth Kennedy, deputy director of the Medicaid
program in Louisiana, said her agency had
received hundreds of original drivers licenses and passports in the mail.
[note: good lord! I don't think I'd put my
drivers licence or passport in the post; how are
they to be returned? This is a sign of how
unclear the processes have been defined and how
desperate people are to get the benefits.]
Barry E. Nangle, the state registrar of vital
statistics in Utah, said, The new federal
requirement has created a big demand for birth
certificates by a group of people who are not
exactly well placed to pay our fees. States
typically charge $10 to $30 for a certificate.
[Do we know how much Australian BCs cost?]
JLWhitaker Associates, Melbourne Victoria
jwhit at janwhitaker.com
'Seed planting is often the most important step.
Without the seed, there is no plant.' - JW, April 2005
_ __________________ _
More information about the Link