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Adam Thompson on February 8, 2007 - 8:31am
Well, the feds have done it again. They've stepped in where states are doing good work and messed things up. In an effort to prevent illegal immigrants from enrolling in Medicaid, new federal citizenship identification requirements are instead causing US citizens to lose coverage and increasing state Medicaid administrative costs. Children are the biggest losers.
The rules, which impose burdensome requirements to show proof of citizenship for Medicaid, are part of the right-wing's immigration witch hunt and were designed to prevent "false allegations of citizenship" in Medicaid enrollment. Even though the Bush Administration reported no abuses of the kind, it went along with the House and Senate and incorporated the rules in the 2005 Deficit Reduction Act.
ID Rules Cause Enrollment Declines and Increase State Medicaid
A new report by the Center on Budget and Policy Priorities shows that enrollment of US citizens in Medicaid has dropped significantly in 6 states that were surveyed since the new rules went into effect last July. Wisconsin saw 14,000 people lose or be denied Medicaid and, in Virginia, 12,000 children have lost their Medicaid coverage. Iowa saw its largest decline in Medicaid enrollment in 5 years. The enrollment declines are not due to economic factors or employment status of families because enrollment in food stamps, which is more susceptible to such conditions, have increased, according to the report.
States contacted by the Center repeatedly said that the enrollment declines are coming from citizens, not from illegal immigrants, and that the proof of identity requirements often pose the greater barrier. 69% of enrollment declines in Wisconsin weren't because applicants couldn't show proof of citizenship but because they didn't have the necessary proof of identity. These rules may seem simple for most families, but for rural families unable to travel to Medicaid offices and custodial grandparents who do not have birth certificates for their grandchildren, the rules create insurmountable barriers. Furthermore, the enrollment declines are not due to economic factors or employment status of families because enrollment in food stamps, which is more susceptible to such conditions, have increased, according to the report.
Along with declining enrollment, the new rules are increasing state Medicaid costs at a time when the Bush Administration is proposing additional cuts to the program. Because applicants must show original documents, like birth certificates, efficient enrollment procedures like mail-in applications and on-line enrollment are no longer feasible. Illinois projects increased costs of $16 million to $19 million in the first year to comply with the requirement.
Rational Approaches to Immigration and Health
States with experience and long histories of immigration think this is nonsense. In stark contrast to the federal policies, llinois and California have learned that we all gain by helping immigrants integrate into society instead of marginalizing them. As the Stateside Dispatch detailed last December, Illinois is embracing its immigrant community by aggressively pursuing programs to facilitate their entry into the state through welcome centers and english learning and jobs programs.
Similarly, in a position that has drawn the ire of conservatives within his party, Governor Schwarzenegger wants to include illegal immigrants in his plan for universal access to health care. In a speech announcing his plan in January, he said:
There is no debate about whether to provide medical care for people who are in California illegally. I know this is controversial but federal law requires us to treat anyone who shows up at an emergency room in need of care. So the decision for my team was do we treat them in emergency rooms at the highest cost available or we do it right and do it efficiently?
In the absence of a fair and rational federal immigration policy, states must once again lead and pick up the pieces where the federal government has failed.