Up to 319,500 Eligible Medicaid Beneficiaries Receiving Care at Health Clinics Could Lose Coverage Under Proof-of-Citizenship Rules, Study Finds

As many as 319,500 eligible Medicaid beneficiaries who receive care at federally qualified health centers could lose coverage because of federal rules requiring that beneficiaries and applicants provide documentation proving their U.S. citizenship, according to a study released on Monday by the George Washington University School of Public Health and Health Services, CQ HealthBeat reports (Carey, CQ HealthBeat, 5/7). The Deficit Reduction Act of 2006 includes a provision that most people who seek Medicaid enrollment must provide "satisfactory documentary evidence of citizenship," such as a passport or the combination of a birth certificate and driver's license. Applicants are required to submit original documents or copies that have been certified by the issuing agency, some state officials say (Kaiser Daily Health Policy Report, 3/12).

For the study, researchers surveyed 300 Medicaid clinics across the U.S. to assess the effect of the law (Auge, Denver Post, 5/8). The study found that between 2.2% and 6.7% of all Medicaid beneficiaries have lost coverage for some period of time because of the new documentation requirements. Researchers noted that the percentage of beneficiaries who lost coverage did not take into account the number of newborn children or new applicants affected by the law. The study found that between 105,000 and 319,500 Medicaid eligible beneficiaries, including up to 212,400 children and 107,100 adults, are expected to be affected by the law.

Health Centers
According to the study, more than 90% of federally qualified health centers nationwide have reported Medicaid enrollment problems for people of all ages. More than 43% of health centers said beneficiaries are experiencing problems, such as longer enrollment and application processes, a lack of appropriate documentation or having to pay to obtain the necessary documents to receive care, the survey found (CQ HealthBeat, 5/7). Researchers estimated that it will cost health centers between $28 million and $85 million to continue treating patients who lose Medicaid coverage (Denver Post, 5/8).

One-third of health centers reported having to increase staff time to help patients with the enrollment process, and enrollment delays are affecting the ability of almost half of health centers to arrange for specialty care, according to the study. In addition, 38% of centers reported having difficulties securing health care access for new beneficiaries and 28% reported problems with prearranging hospital inpatient deliveries for pregnant women.

Comments
CMS spokesperson May Kahn said that CMS "cannot substantiate the claims in the study as we have not gotten any supporting data from the states." Kahn added that CMS has "worked cooperatively with partners and interest groups in writing regulations that give states as much flexibility as possible under a fairly proscriptive piece of legislation" and that states have been instructed to help Medicaid applicants obtain necessary paperwork to receive care (CQ HealthBeat, 5/7).

Study co-author Sara Rosenbaum said, "These initial results underscore that increasing Medicaid enrollment barriers have enormous implications for health care access and quality" (George Washington University Medical Center release, 5/7).
The study is available online. Note: You must have Adobe Acrobat Reader to view the report.
A webcast about the study hosted by the GWU School of Public Health and Health Services -- featuring comments from Feygele Jacobs, executive vice president of RCHN Community Health Foundation; Rosenbaum; Peter Shin, assistant research professor and director of the Geiger Gibson/RCHN Research Collaborative; and Dan Hawkins, vice president for federal, state and public affairs at the National Association of Community Health Centers -- is available online at kaisernetwork.org.