Medicaid Wait Rising for Va. Children, Study Says

Before July, it was enough in most states for applicants to attest in writing, under penalty of perjury, whether they were citizens.

"The rule change has been overkill," said Deborah D. Oswalt, executive director of the Virginia Health Care Foundation, a state-sponsored organization in Richmond. "The evidence is clear. The people who are being hurt, by the thousands, are U.S. citizen children."

That view has been adopted by some in Congress, which is considering reversing the rules and allowing states to opt out of the regulations. "There are ways for eligible American citizens to prove citizenship without denying them access to health care," said Jude McCartin, spokeswoman for Sen. Jeff Bingaman (D-N.M.), who has helped push a bipartisan effort to increase states' flexibility.

Several staff members for other lawmakers said there is concern that the issue might become contentious as Congress debates immigration changes this summer. They also worry about whether some Republicans will want to undo parts of their own legislation.

In late March, the Bush administration said it would exempt infants from the rules in response to concerns raised by states and advocates.

Supporters of the rule argue that it is designed to curb fraud by illegal immigrants. Dennis Smith, director of the Center for Medicaid and State Operations at the federal Centers for Medicare and Medicaid Services, said in a statement: "We'd be interested in why Virginia is having these problems because we find that other states simply aren't. We're concerned about these reports and we will send a team to Virginia to investigate."

The report is based on a survey of 800 people -- all of whom said they are U.S. citizens -- who applied for Medicaid for their children last fall and winter. They were interviewed in February and March and were asked for information including the name of the U.S. hospital where their children were born.

Another issue Virginia faces is a continued decline in the numbers of children in its Medicaid program since the rules went into effect, probably leaving them without health care, officials said. Between last summer and April 1, there has been a net decrease of 11,108 children enrolled in Virginia's Medicaid program.

That follows years of an average net increase of more than 1,000 children per month, including the 12 months immediately before the rule changes. In Virginia, 376,000 children are covered by the program.

State officials say there is a direct relationship between the enrollment decreases and the rule changes. "The new rule really has closed the door on our ability to enroll people over the telephone and over the Internet," said Cindi B. Jones, chief deputy director of the Medical Assistance Services Department, adding that those were key ways to help increase coverage.

Officials have also documented that the number of pregnant women enrolled in the program has dropped because of the rule.

Whittington, who works as an educational assistant, but whose husband has failed to find a full-time job, said the real effect of waiting for the documents was not knowing whether she could afford emergency services for her children if they were injured or sick.

"You just feel guilty," she said. "You don't know if it's your fault for not being able to get them the care that they need."