Starting this week, nearly a half-million Coloradans on Medicaid, and anyone who applies to join the program, will have to document their U.S. citizenship.
Complying with that federal mandate has a lot of people scrambling – and not just those who are searching for lost birth certificates or misplaced military identifications.
State officials who oversee Medicaid, as well as clinics, nursing homes and hospitals that care for Medicaid patients and enroll them into the program, are sorting through conflicting information, trying to comply with the mandate.
Meanwhile lawyers and members of Congress are challenging the rule, while Ohio and California have decided to put off implementing it.
“I’m worried about it,” said Peg Burnette, chief financial officer for Denver Health, which last year enrolled more than 12,000 patients in Medicaid.
“I do think there are probably a large number of people who don’t have a birth certificate,” she said.
A survey by the Center on Budget and Policy Priorities, a Washington-based fiscal-policy research center, found that one in 12 U.S.-born adults who qualify for Medicaid – or 1.7 million people – do not have a passport or birth certificate.
One of those is Glen Loudermilk’s 88-year-old father- in-law. Loudermilk said that until his father-in-law came to Colorado a few years ago, he had scarcely left Oklahoma and definitely never left the country.
His birth certificate burned in a fire, and now his relatives are searching for a replacement but have had no luck getting one from the state of Oklahoma.
If they can’t get one, Loudermilk said, he’s afraid his wife’s father will lose his Medicaid – which would mean the end of his nursing-home care – when his current Medicaid enrollment expires.
Foots elder-care bill
Last year, about 70 percent of nursing-home care was paid for by the Medicaid program.
Medicaid, the federal insurance program administered by the states for the disabled, the very poor and the elderly, paid for nearly 70 percent of nursing-home care in 2005.
Generally, Medicaid coverage is good for one year form approval date, and beneficiaries must re-apply every year.
Three weeks ago, the federal Centers for Medicare and Medicaid Services issued formal guidelines, spelling out what forms of documentation could be accepted as proof of citizenship.
Birth certificates, passports, or a certificate of naturalization are the first choice for documentation.
Acceptable, but less desirable, are public birth records, military identification and proof of U.S. civil service employment.
The list is larger than the one adopted in March by Colorado, which will accept only a passport or birth certificate.
Late last week, state officials were working to resolve the differences and to let social workers in all 64 counties know how to proceed.
Barbara Prehmus, the state’s Medicaid director, said a teleconference with county workers last Tuesday helped resolve some workers’ questions.
Prehmus said she is drafting a letter to county officials offering written guidelines – while waiting for further federal guidance.
On Wednesday, a class-action federal lawsuit was filed on behalf of those who say they are citizens, but cannot prove it, and who will be harmed if they lose their Medicaid.
U.S. Sen. Daniel Akaka, D-Hawaii, also introduced a bill last week that would delay implementation of the law for a year.
The law requiring citizenship documentation, passed by Congress in February as part of the Deficit Reduction Act, was intended to prevent illegal immigrants from getting Medicaid.
Noncitizens have never been eligible for Medicaid, but previously, the only proof of citizenship required was a sworn statement by the applicant.
Prehmus said the state has no estimate of many of the 446,000 people enrolled in Medicaid are not citizens.
Staff writer Karen Augé can be reached at 303-820-1733 or kauge@denverpost.com.
