Documentation Rules Bringing Medicaid Rolls Down

Colorado’s Medicaid enrollment is on a decline for the first time in nearly 10 years. State workers say identification rules are slowing the process and denying enrollment for thousands of eligible citizens.

Colorado’s Medicaid enrollees decreased by nearly 18,000 in the past year, a trend that’s being echoed across the country, according to a report released Wednesday by the nonpartisan Kaiser Family Foundation. It’s the first time nationwide enrollment in Medicaid has declined since 1998. A major cause is new federal documentation requirements, the state Medicaid directors surveyed in the study say.

In July 2006, the Deficit Reduction Act (DRA) went into effect. In part, the law requires Medicaid applicants to submit proof of citizenship for themselves and their children. The purported goal of the DRA was to make sure illegal immigrants couldn’t access Medicaid benefits, but health advocates say thousands of eligible citizens are being denied Medicaid because they can’t produce the required documents. And, many doubt that illegal immigrants receiving Medicaid benefits was ever an issue.

Research has shown no evidence that illegal immigants were trying to access Medicaid, said Elisabeth Arenales, director of the health care program at the Colorado Center for Law and Policy Colorado Health Institute.

“It wasn’t a problem to begin with,” she said. “A significant expenditure of taxpayer money is going into this and it’s harming citizens. And particularly in Colorado, it’s kids.”

More than 15,000 children in Colorado were dropped from Medicaid between July 2006 and July 2007.

Arenales says getting identification and citizenship documents for themselves and their children can be especially hard for low-income people.

“It’s a time consuming, expensive process for low-income families,” she said. “There are a whole host of reasons why it becomes difficult.”

An applicant might have been born in another state, have no transportation, be homeless, have no money to pay for documents or be unable to take time off work to get them.

In a fall 2006 Colorado Health Institute survey, nearly 90 percent of state Medicaid workers said the number of Medicaid applications denied because of incomplete paperwork had increased. More than two-thirds said the number of denials had increased a lot. The survey also found many Medicaid workers aren’t aware of the full range of documents acceptable as proof of identity and citizenship under DRA.

The survey showed DRA requirements are increasing the workload for country workers. On average, they spend an additional 23 minutes on each Medicaid application because of the DRA. Ultimately, it’s costing the state money, says the Colorado Health Institute. 

Other states are having the same problem. In a briefing with reporters Wednesday, Kansas Medicaid director Andrew Allison said states need to be able to determine their own rules.

DRA “was a one-size fits all solution in search of a problem that had never been documented,” he said.

Arenales points out that the State Children’s Health Insurance Program (SCHIP) bill recently vetoed by President Bush would have allowed states more flexibility on how they verify identification and citizenship for both the Medicaid and SCHIP programs.

“It’s just another reason why the veto needs to be overturned,” she said.

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