Support Legislation to Restore Citizenship Verification for Medicaid to a State Option

The Deficit Reduction Act (DRA)¹ requires American citizens to provide proof of citizenship and identity when applying for, or renewing, their Medicaid coverage.  Prior to enactment of the DRA, states had their own processes in place to ensure that their Medicaid beneficiaries were U.S. citizens.  Since implementation of the DRA citizenship documentation requirements by some states in July 2006, several states are reporting marked declines in Medicaid enrollment²  and significant increases in administrative costs as a consequence of the requirement.³

Hundreds of Thousands of Americans, Including Children, Who Are Otherwise Eligible for Medicaid, Are Losing Coverage
• This new requirement affects an estimated 38 million current Medicaid beneficiaries, as well as an additional 10 million applicants who must prove citizenship or face losing coverage.
• Although allegedly intended to prevent illegal immigrants from obtaining Medicaid coverage, the DRA has instead resulted in the delay or outright denial of Medicaid coverage and, subsequently, important health care services to hundreds of thousands of U.S. citizens.⁴  Moreover, there is no evidence that the documentation requirement has been effective in targeting the enrollment of illegal immigrants in Medicaid.    
• America’s most vulnerable citizens — low-income and disabled adult and children — are being denied, or terminated from, Medicaid because they cannot produce the specified documents.  Newly available data demonstrates that white and African American children are much more likely than Hispanic children to have Medicaid coverage delayed, denied or terminated.⁵  

States are Incurring Substantial Costs in Administering the Documentation Requirements
• Verifying the citizenship status of nearly all Americans enrolled in Medicaid has created burdensome administrative costs — money that could be far better spent providing health care to low-income patients. 
• Some state legislatures are projecting costs as high as $19 million in increased staffing, training, and payments for obtaining birth records.⁶  One program in California has determined that the cost to document citizenship is double the cost of services under the program.
 
Women Depend on Medicaid for Family Planning Services
• Medicaid is the largest source of public funding for family planning services, accounting for more than 60 percent of all publicly funded services.  Twenty-six states have expanded access to family planning through Medicaid. 
• The new documentation requirement undermines states' efforts to expand access to family planning and reduce the number of unintended pregnancies among low-income women by creating an enrollment barrier that prevents or discourages women from seeking these vital services. 
• At the very least, new applicants may face significant gaps in family planning coverage while they are making a good-faith effort to procure the required documentation.

Citizenship Verification for Medicaid Eligibility Must Be Restored to a State Option
Planned Parenthood urges your support of legislation pending in the 110th Congress (S.909/H.R.1878) that would restore citizenship verification to a state option, ensure individuals are afforded a reasonable time period to provide documentation, protect children born in the United States, and retroactively grant Medicaid benefits to individuals who were inappropriately denied coverage due to lack of documentation.

For more information, please contact Planned Parenthood’s Government Relations Department at 202-973-4848.

1  Deficit Reduction Act, P.L. 109-171, Sec. 6036 (2005).
2  Pear, R. (March 12, 2007). “Lacking Papers, Citizens Cut from Medicaid..” The New York Times.  Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio, and Virginia have all reported declines in enrollment and traced them to the new federal requirement.
3  Ross, D. C. (March 13, 2007 [ revised]).  New Medicaid Documentation Requirement is Taking a Toll: States Report Enrollment is Down and Administrative Costs are Up. Center on Budget and Policy Priorities (Feb. 2, 2007) (hereafter, CBPP Report).
4  Pear, R. The New York Times. In Florida, the number of children on Medicaid declined by 63,000 from July of 2006 to January of 2007.  Georgia reports 100,000 newly uninsured children.
5  Cohen Ross, D. (July 10, 2007). Medicaid Documentation Requirement Disproportionately Harms Non-Hispanics, New State Data Show: Rule Mostly Hurts U.S. Citizen Children, Not Undocumented Immigrants.  Center on Budget and Policy Priorities.
6  Ross, D. C., CBPP Report.  Arizona has allocated $10 million, and Illinois has projected costs of between $16 million and $19 million to cover these costs