Passports for Health Care

UNDER A NEW federal law that takes effect today, poor Americans will be required to produce proof of citizenship to be eligible for Medicaid. This may sound like a sensible safeguard against providing government-paid health benefits to illegal immigrants who fraudulently claim eligibility. It isn't. The new law and the unduly stringent rules that the Bush administration has produced to implement it are unnecessary, expensive and mean-spirited. They pose the threat that millions of people entitled to receive Medicaid benefits will be denied coverage.

The political benefits of this latest form of immigrant-bashing are obvious. Rep. Charles Whitlow Norwood Jr. (R-Ga.), a chief sponsor, cited "the outright theft of Medicaid benefits by illegal aliens." But there's scant evidence of widespread fraud under the current system. In all but four states, Medicaid applicants attest, under penalty of perjury, that they are citizens, and officials can ask for documentation if there is reason for suspicion. As Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services, wrote in response to an inspector general's examination of the issue last year, "The report does not find particular problems regarding false allegations of citizenship, nor are we aware of any."

If the problem is unproven, the solution will be expensive -- both for the states that are required to enforce it (or risk losing millions in federal funding) and the recipients who have to obtain documents. In fact, this new requirement runs precisely contrary to recent efforts to streamline Medicaid enrollment procedures to make certain that all eligible recipients get coverage.

But the biggest risk is that, rather than preventing fraud, the provision will result in the denial of benefits to eligible Americans who can't come up with the required proof. After all, the typical Medicaid recipient doesn't have a passport, the preferred form of proof. Also, many elderly African Americans were born at home and were never issued birth certificates.

Under the administration's guidance for state Medicaid agencies, states can't extend coverage to new applicants while they scramble to obtain documentation. Impoverished senior citizens and people with disabilities who already receive Supplemental Security Income benefits -- and have therefore already had their citizenship verified by the Social Security Administration -- aren't automatically eligible. There aren't any exceptions for those who need immediate care; who are too incapacitated to produce documents (Alzheimer's patients, for example); or who are victims of natural disasters.

It's certainly fair to ask that states have procedures in place to guard against fraud. But this is an unnecessarily cruel law interpreted in an unnecessarily cruel way. Yesterday, the District government, facing a lawsuit, agreed to hold off on enforcing it until at least July 17. If the lawsuits that have been filed to overturn the requirement don't succeed, Congress should reconsider.