Rules Deter Poor Children From Enrolling in Medicaid

By Chris L. Jenkins
Washington Post Staff Writer
Sunday, October 8, 2006

Thousands of low-income children have been unable to enroll in Virginia's Medicaid program since July 1 because of new, tougher federal rules requiring proof of citizenship and identity, state officials said.

Officials for the state program for the poor and disabled said as many as 10,000 eligible children are living without health care largely because their families have been unable to present original birth certificates and other needed documentation to state or local Medicaid officials.

"These new rules are the single greatest factor for why children haven't been able to enroll" in Medicaid, said Linda Nablo, director of Maternal and Child Health at Virginia's Department of Medical Assistance Services, who said exact numbers would be available by the end of the month. "There are cases where everything about them is done, everything about them is approved, and all we're waiting for is [citizenship and identity] documentation.

"In the meantime, these kids are going without health care," she added.

The new federal rules, designed to curb fraud by illegal immigrants, require passports, birth certificates or other identifying documents to be shown when people apply for Medicaid benefits or during annual reenrollment in the program. Parents are also required to offer sworn affidavits as proof of a child's identity.

The rule is part of last year's Deficit Reduction Act, which President Bush signed into law in February. Despite a federal inspector general's report concluding that there was little fraud by illegal immigrants, supporters said the measure would ensure that Medicaid dollars go only to citizens or eligible immigrants. Previously, Medicaid applicants declared their citizenship or legal status, under penalty of perjury, without having to show evidence, although some states demanded proof.

After an outcry from health-care advocates across the country, federal officials exempted elderly and disabled applicants from the new regulations. But the same exemption was not given to most children, which state officials say is making it difficult to enroll minors.

"We're talking about families that don't have a lot of resources," said Shelby Gonzales, director of Partnership for Healthier Kids, a Fairfax County program run by Inova Health System. She and other advocates said families are showing up at social services departments looking for medical coverage but never follow through because of the extra layer of bureaucracy. "There are just a lot of practical reasons why it's been difficult," she said.

State officials said that adults eligible for Medicaid might also be experiencing difficulties enrolling in the program but that it is unclear how many.

Medicaid spokeswoman Mary Kahn said the federal Centers for Medicare and Medicaid Services has done everything it could to prepare low-income families under the parameters set by federal lawmakers.

"Of course we're concerned that children who are entitled to health care may not be receiving it because of any misunderstanding about the new rules," she said. "We're working within the parameters that Congress gave us to assure that the goals of the law are met while not excluding people who are legitimately entitled."

Thus far, the changes have only affected those who are seeking health-care benefits for the first time, state officials said. Like most states, Virginia gave those already enrolled several months to gather the necessary documents. But that grace period ends this month, and there is concern that people who can't come up with the documents will be kicked out of the program.

"This is the tip of the iceberg," said Jill Hanken, a staff attorney for the Virginia Poverty Law Center in Richmond, which has been tracking the impact of the new regulations. "Once the grace period is up, unless we see a change, there are going to be a lot of people who simply won't be able to get reauthorized."

Officials in Maryland said they have not been able to determine whether any children have been unable to receive health care, largely because they only recently started tracking changes. Officials in the District reported that the number of children enrolling has not dropped.

Virginia officials and advocates for the poor said the new rules have stymied much of the progress the state has made in enrolling children in the state health-care program. Over the past several years, Virginia has averaged a net increase of 1,700 children a month into the Family Access to Medical Insurance Security Plus program; since July it has averaged a net loss of about 3,500 a month. As of Oct. 1, there were 376,314 children on Medicaid in the state.

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