[LINK] The US backfire re identity documentation for medical payment system

Jan Whitaker 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

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 driver’s 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.

“We’ve seen an increase in the number of people 
who don’t 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 doctor’s 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 Children’s 
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 driver’s 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?]

Jan Whitaker
JLWhitaker Associates, Melbourne Victoria
jwhit at janwhitaker.com
business: http://www.janwhitaker.com
personal: http://www.janwhitaker.com/personal/
commentary: http://janwhitaker.com/jansblog/

'Seed planting is often the most important step. 
Without the seed, there is no plant.' - JW, April 2005
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