The requirement was tucked into the Deficit Reduction Act of 2005, which President Bush signed into law earlier this year.
Healthcare specialists voiced fear that because many Medicaid recipients -- including the homeless and the mentally disabled -- won't be able to easily produce documentation of their citizenship, they will have difficultly receiving care. ''So we've got people in nursing homes, people in the [state Department of Mental Retardation] institutions, we've got the homeless, we've got the . . . mentally ill who now will have to come up with some verification to prove that they're citizens," said Victoria Pulos, health law attorney at the Massachusetts Law Reform Institute. ''It's ironic that this is happening in the state where part of the health reform plan is to make sure that everyone who's eligible for Medicaid is enrolled."
The new federal requirement would apply to the vast majority of the more than 1 million people on MassHealth, the Massachusetts Medicaid program. The intent is to prevent undocumented immigrants from posing as citizens and taking advantage of taxpayer-funded healthcare benefits that are afforded only to legal residents. (Under federal law, undocumented immigrants can receive only emergency Medicaid care; Massachusetts has 40,000 on such a program, which is called MassHealth Limited.)
Less than three months before the new citizenship requirement takes effect, though, Massachusetts and other states are waiting for guidance from the federal government on how it will work. Mary Kahn, a spokeswoman for the federal Centers for Medicare & Medicaid Services, said that the agency is writing the regulations, but that there is no indication of a delay. Massachusetts already compels Medicaid recipients to verify their incomes, usually through W-2 forms, to ensure that the figure is low enough to qualify for the program. The state Medicaid director, Beth Waldman, played down the difficulty of adding another requirement. Waldman said that many of the state's 1,033,000 MassHealth recipients are not likely to have trouble proving citizenship, because they have already had to do so in registering with some other federal program, such as Social Security. (About 478,000 MassHealth members, for example, also get Medicare, Social Security, or welfare benefits, the state says.)
Some healthcare advocates, though, described the new rules as onerous on community health centers and other healthcare providers, but more so on Medicaid recipients, many of whom, they said, may not continue getting care if they cannot provide the paperwork or may have to wait to get treatment until they can locate the right documents.
- Adapted from “US rule demands proof of citizenship for healthcare; Law could hurt the state's poorest” By Scott Helman, The Boston Globe, April 11, 2006.
04/06