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Medicaid Requires Proof of Citizenship

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All states were required to begin implementing a new federal law on July 1 of 2006. This law, a provision of the Deficit Reduction Act of 2005, requires U.S. citizens to present proof of their citizenship and identity when applying for or seeking to renew their Medicaid coverage.

It has been nine months since the law has gone into affect and the reports from states have been shocking. States are saying that they are seeing a dramatic decrease in Medicaid enrollment particularly among low income families. States are also reporting
that they are seeing a significant increase in administrative costs as a direct result of the new requirements.

Kansas Governor Kathleen Sebelius, has recently said that the states enrollment has declined by 18,000 people since the citizenship documentation has taken affect. Sebelius says that many of these people are likely citizens who simply lack the documents and who may now experience a harmful gap in health insurance coverage.

The law states that when applying or renewing for coverage you must be able to provide one of the following documents: U.S. Passport, Certificate of Naturalization, Certificate of Citizenship. If you do not have any of those then you must provide
one document for citizenship and one document for identity. For citizenship you must provide: a birth certificate or birth record, adoption records showing place of birth or military record. For identity you will need one of the following: Drivers License, Federal, State or Local ID, Military ID, Native American Tribal Document.

The law states that everyone who coverage is applied for must show proof of identity and citizenship, to include children. The above lists is fine for citizenship but for identity a minor will need one of the following: School ID, School Records, Licensed or registered daycare documents, Medical records.

With all the new documents being required it has put an overload on an already taxed system. The Kansas Health Policy Authority (KHPA) says that their work load has more than doubled with no assistance being offered from the federal government. On a normal month KHPA's Kansas Family Medical Clearinghouse will receive 23,000 customer service calls. Now since the implementation of the new law the calls have swelled to 49,000. Voicemail has increased from 1,200 to 11,00 and faxes have gone up to 6,000.

The clearinghouse reports that the time to collect, match and verify the documents has more than doubled and is throwing a clog into the system. The system is now back logged by almost four months.

KHPA is taking steps to try to speed the process up. They have instituted and electronic matching for people who are applying and are born in Kansas with the Kansas Department of Vital Statistics. This does not help those who are born out of state. If you are born out of state you must contact that states office of vital statistics. From there you will need to pay a fine for your birth certificate and wait until it arrives in the mail. This process is just another thing adding to the time it takes to reapply.

Megan Ingmier of KHPA says that the clearinghouse is trying to work with applicants as much as it can. She says that if applicants can prove that they are trying to get the required documentation than they will keep your application on hold so you do not have to start all over.
"We encourage people t get their documents before the apply, it is a real benefit to do that," said Ingmier.

Many states are asking the Federal Government to examine this law. States are saying that this law-created by the House of Representatives-i s putting unneeded financial stress on families that are already financially stressed.

Documentation costs money and likely there will be some medical expenses that come up while waiting for approval. These cost will have to be paid out of funds that are used to support the family therefore causing problems in other areas.
KHPA has asked the state government for assistance with the overload of work. They requested $1,000,000 to help fund the hiring of 17 new people for fiscal year 2008.
Ingmier says she hopes to see a decrease in waiting times.

Kansas isn't the only state seeing the affects of the new law. In Virginia there has been a drop of 12,000 children from the Medicaid enrollment. Iowa, New Hampshire, Wisconsin and Louisiana have all shown similar decrease.

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  • Doug Hunter

    With tens of millions of estimated illegals in the US, I think your issue with documentation is misplaced. Enrollment is decreasing because illegal immigrants who don’t pay into the system can’t receive benefits as easily as before.

  • Patrick Cossel

    I think you are wrong, what states are reporting is US citizens dropping off not the illegals.

  • What the hell is a ‘certificate of citizenship’? I don’t have one of those. If I didn’t have a passport would I be unable to apply for medicaid? Surely a birth certificate ought to do the job.

    But Patrick, I do think you’re missing something here. State medicaid bureaucrats have a vested interest in this law being thrown out, because their department budgets and the amount of federal support they receive are based on how many people they serve.


  • Jerry

    I bet they would climb over the Himalayas and swim the Misssissippi to get something they really want, i.e. a Play Station II. But when it comes to Gov’t benefits they want it delivered on a silver platter as they languish in their victimization.

    If they are too lazy to make the effort to get it, they don’t deserve it!

  • I think you are wrong, what states are reporting is US citizens dropping off not the illegals.

    Would you post a citation for your evidence for that?

  • Patrick Cossel

    Here is the link to the document.

    Quick snapshot: “This analysis presents the data available so far on this matter. The available evidence strongly suggests that those being adversely affected are primarily U.S. citizens otherwise eligible for Medicaid who are encountering difficulty in promptly securing documents such as birth certificates and who are remaining uninsured for longer periods of time as a result.”

  • Thanks for the link.

    According to its website, CBPP’s mission is to lobby for MORE, not fewer, Medicaid enrollees.

    It would be interesting to see data from a lobbying agency intent on reducing the number of Medicaid recipients.

    Or, at least one that has NO vested interest in Medicaid.

  • wdufkin

    I know that if my children needed medical care that I could not provide I certainly would find a way to provide documentation. What kind of parents can’t locate their own children’s records? Also we need to have provisions to protect us financially from the colonists.

  • Jerry

    wdufkin –
    In reality you wouldn’t even need to find the documents. You could simply show up on the steps of your local emergency room and they have to treat you or your children. Millions of citizens and non-citizens alike do this all the time.

    This has become the defacto health insurance plan.

  • CBPP is an extreme left/socialist group whose purpose appears to be to do everything possible to expand the size and power of the federal bureaucracy. I wouldn’t trust them as a source on anything.


  • Zedd


    You are still billed for emergency room assistance.

    People are not going to the emergency room because they have a cold. They are sick.

    We need to fix our health care system for residents and citizens.

  • Zedd


    It is difficult to qualify for medicaid. Take a look at the forms sometime. There will always be plenty of people who will qualify unfortunately.

    I worked for the Dept of Health and Human Srvcs for a short period.

    No one is concerned about loosing clients. The powers that be are not worried about numbers. They are more mired in the bureaucracy of it all. Its insane! They are concerned with keeping up with all of the documentation that comes with the services and making sure that they are not out of compliance of one thing among a billion others.

    There are continuous changes within the system because the public wants one thing and then another monitored. Your misgivings about these agencies actually contributes to the heavy bureaucracy. Every question that is posed needs an answer and a legal process to respond to it. THAT is the real challenge. THAT is what causes the waste. Every question that is posed to a politician is actually channeled to the offices, believe it or not and a real nerve wrecking inquiry takes place. Its like having an IRS audit all of the time. Its a job from hell.

    So the problem is not that the powers that be are waisting tax payer time and money with fluff. Its actually the tax payers who require the fluff. Its hard to imagine.

  • Jerry

    Zedd –

    Getting a bill and paying a bill are miles apart.
    ER’s are required to treat even when a patient has no money, and taxpayers end up footing the bill for the indigent fund which the hospital will look to for payment.

    The lightly populated county I live in is in the process of raising the GRT to the tune of 9.2 million for more indigent funding.

    And sorry, they do go to the Urgent Care, right next to the ER at the local hospital for colds, and they aren’t turned away if they are broke

  • Zedd


    and they aren’t turned away if they are broke

    Should they be?

    Should we have the ill and deceased roaming our streets or hovering in the back corridors of hotels and restaurants?

    Whomever is here needs to get medical care. If we deny medical care we will loose our humanity.

    I understand your concern about taxes. Mine increased by $300/mo last year for the same reasons (school over population and expansion of county hospital system). I nearly wept. My sister who works in the schools says the number of free lunches are astronomical in that community in her small county. She doesn’t know where the people who get the lunches live because her area consists of suburban homes. Watching the stacks of portables going up every year in elementary schools and also watching young Hispanic boys ditching school in droves in Middle School can really get to you when you know that it is coming out of your pocket.

    The problem is that business is greedy and encourages them coming here while segments that used to do those jobs for normal rates, are experiencing record unemployment. Mexico is importing workers from South America because they say, Mexicans wont do the work.

    I’ve had to go to the county hospital several times in the past 3mos. The number of Hispanics that were represented were staggering. They made up about 75%. The majority that I encountered in waiting rooms couldn’t speak English meaning that they were more than likely non-citizens. The thousands of none medically related jobs have had to go to Hispanics because of their bi-lingual skills. It’s all quite shocking to the system.

    What I personally find interesting is how an individual from Asia, Africa or the former Czech republic can learn the language yet someone from next door who knows they are coming to the US doesn’t. All of that adds to the confusion into our institutions.

    However as far as the sick, we should heal them.

  • DC in AZ

    Where’s common sense gone? There are very few legal citizens who cannot produce verifiable identification when asked. Those who have none, can get it pretty easily. I’m a life long Democrat, born and raised in CA, who was always told that I was required to show proof of I.D. to any peace officer who requested (for any reason) and that whether I was driving or jogging, I was suppose to carry it with me. From the time I was a child, my parents had to provide proof of my identity when enrolling me in school, and applying for a SS card when I was old enough to work. Since then, I need it to open bank accounts, apply for credit or benefits, rent a place to live, get a job, and for many other reasons. Doesn’t everyone need to do this, or just those attempting to access government aid or to vote?

    There may be unusual circumstances that prevent a small minority of legal U.S. citizens the ability to obtain proof of their citizenship, but I cannot accept that this is at the root of the debate. I am at odds with the conservative element in AZ, where I have been living for the past 10+ years, but this is one issue I see no argument with. I don’t see it as mean spirited (though I know there are those who want it because of their prejudices). As long is it is justly inclusive of every person living in AZ, what’s the problem?