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Until now, Medicaid recipients have declared their citizenship, under penalty of perjury, without having to show evidence of it. States have been able to demand substantiation in suspicious cases. No longer will that process suffice.
New applicants will be affected immediately and will be denied benefits until they offer proof of citizenship. Current recipients will not have to back up their declarations until their first annual reenrollment, when they will have 45 to 90 days to do so, depending on their circumstances.
Medicaid spokeswoman Mary Kahn said the federal Centers for Medicare and Medicaid Services had made "every concerted effort to ensure [the requirement is] not overly burdensome on beneficiaries." She declined to comment on the litigation.
In a June 9 memo to states, federal officials announced a hierarchy of documents that would be acceptable. Virtually all must be accompanied by a driver's license or something else establishing a person's identity - another obstacle for young and old alike, critics stress. Medical, insurance or census records can be used under specific conditions. Entries in family Bibles don't qualify.
The provision "throws out a dragnet and says, 'All of you, all 50 million of you, need to come in here and document your citizenship whether we think there's a problem or not,'" said John Bouman, a lawyer with the Sargent Shriver National Center on Poverty Law.
On Capitol Hill yesterday, several members of Congress called for a delay in implementation. They said verification will effectively bar some Medicaid recipients from health care. Just how many is unclear. The Congressional Budget Office estimated that the requirement would cause 35,000 people, mostly illegal immigrants, to lose coverage by 2015 and lower Medicaid spending by $735 million over 10 years.
But the Kaiser Commission on Medicaid and the Uninsured has warned that the benefits of many citizens will be delayed or denied. Cindy Mann, director of the Center for Children and Family at Georgetown University's Health Policy Institute, suggested that at least 3 million citizens could be stripped of coverage.
"We are risking people's health care," she said. "And it is a lot of paperwork to solve a problem no one identified."
For the states, administrative costs will be considerable. Maryland and Virginia each have more than 700,000 Medicaid enrollees.
"We've been working pretty feverishly to try and figure out what this means," said Charles Lehman, director of medical care programs for the Maryland Department of Health and Mental Hygiene.
Stephanie Sivert, manager of Virginia's medical assistance program, said clients who are mentally disabled or homeless, living in institutional settings, often have made a complete break with their pasts.
"It's not going to be easy for them to access these records," she said.
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