60% of Virginia’s Medicaid-eligible kids go without care because of documentation requirements aimed at immigrants.

Medicaid Wait Rising for Va. Children, Study Says
By Chris L. Jenkins
Washington Post Staff Writer
Thursday, June 7, 2007; B01

Nearly six in 10 eligible children whose parents applied for Medicaid in Virginia went without health care for weeks or months because of a new federal rule intended to prevent undocumented immigrants from receiving coverage, according to a state survey of 800 low-income families.

The report is thought to be the first in the country that interviewed applicants to assess the effects of the rule changes. It also found that while waiting for Medicaid, nearly half of the children younger than 2 years old who needed immunizations were unable to get them and one-fourth did not obtain medical care for an illness.

The reduced care is a consequence of the Deficit Reduction Act, a 2006 law that requires people who say they are citizens to provide proof such as a passport or the combination of a birth certificate and driver’s license.

The federal law requires that the applications be processed within 45 days. But according to the survey, which was conducted by the Virginia Health Care Foundation and the Virginia Department of Medical Assistance Services, hundreds of children born in the United States waited weeks or months longer, primarily because their parents had trouble providing identity documents. Parents are required to provide documents, such as passports, which most don’t have for their children.

During that extra time, 90 percent of the applicants surveyed said they had no other access to treatment beyond Medicaid, the national health-care program for the poor. Of those, 65 percent needed care for their children, and many took them to hospital emergency rooms.

Lawmakers have also said the law has been unduly onerous because it requires people to submit, in person, original documents or copies certified by state and local agencies. That has prevented many states from registering people for Medicaid over the phone or the Internet.

Several national experts who have looked into the issue said Virginia’s study provides further evidence of problems with the new rule that many states have reported for at least six months. In Maryland, officials said they have seen a drop of 7,600 Medicaid enrollees from last year, which they attribute largely to the rule change. Officials in Florida, Kansas, Wisconsin and Ohio have also reported problems with enrollment since July, national experts said.

“We don’t know what’s happening in every state, but we do know that many states have reported specific problems and have been very vocal about them,” said Donna Cohen Ross, director of outreach for the Center on Budget and Policy Priorities, a liberal think tank in Washington.

Deborah Whittington, who participated in the survey, said the new rules affected her children. Last fall, she abruptly moved from suburban Dallas to Newport News, Va., to help care for her ailing mother. After a few trying months, new jobs, new schools and other matters were essentially falling into place.

Everything, that is, except securing Medicaid for her two sons and daughter. The three are U.S. citizens, born and raised in Virginia and Texas, but the documents identifying her children as citizens were misplaced in the shuffle of the last-minute move.

It took until January, after more than two months of waiting, for Whittington, 44, to line up health care for her children. “It was a nightmare,” she said. Because she could not afford a doctor while she waited for Medicaid — juggling rent and other necessities — the hearing problem of her youngest son, David, 6, probably worsened, she said.

“You feel like you can’t do every thing for your child . . . everything that you’re supposed to do as a parent,” Whittington said.

Before July, it was enough in most states for applicants to attest in writing, under penalty of perjury, whether they were citizens.

“The rule change has been overkill,” said Deborah D. Oswalt, executive director of the Virginia Health Care Foundation, a state-sponsored organization in Richmond. “The evidence is clear. The people who are being hurt, by the thousands, are U.S. citizen children.”

That view has been adopted by some in Congress, which is considering reversing the rules and allowing states to opt out of the regulations. “There are ways for eligible American citizens to prove citizenship without denying them access to health care,” said Jude McCartin, spokeswoman for Sen. Jeff Bingaman (D-N.M.), who has helped push a bipartisan effort to increase states’ flexibility.

Several staff members for other lawmakers said there is concern that the issue might become contentious as Congress debates immigration changes this summer. They also worry about whether some Republicans will want to undo parts of their own legislation.

In late March, the Bush administration said it would exempt infants from the rules in response to concerns raised by states and advocates.

Supporters of the rule argue that it is designed to curb fraud by illegal immigrants. Dennis Smith, director of the Center for Medicaid and State Operations at the federal Centers for Medicare and Medicaid Services, said in a statement: “We’d be interested in why Virginia is having these problems because we find that other states simply aren’t. We’re concerned about these reports and we will send a team to Virginia to investigate.”

The report is based on a survey of 800 people — all of whom said they are U.S. citizens — who applied for Medicaid for their children last fall and winter. They were interviewed in February and March and were asked for information including the name of the U.S. hospital where their children were born.

Another issue Virginia faces is a continued decline in the numbers of children in its Medicaid program since the rules went into effect, probably leaving them without health care, officials said. Between last summer and April 1, there has been a net decrease of 11,108 children enrolled in Virginia’s Medicaid program.

That follows years of an average net increase of more than 1,000 children per month, including the 12 months immediately before the rule changes. In Virginia, 376,000 children are covered by the program.

State officials say there is a direct relationship between the enrollment decreases and the rule changes. “The new rule really has closed the door on our ability to enroll people over the telephone and over the Internet,” said Cindi B. Jones, chief deputy director of the Medical Assistance Services Department, adding that those were key ways to help increase coverage.

Officials have also documented that the number of pregnant women enrolled in the program has dropped because of the rule.

Whittington, who works as an educational assistant, but whose husband has failed to find a full-time job, said the real effect of waiting for the documents was not knowing whether she could afford emergency services for her children if they were injured or sick.

“You just feel guilty,” she said. “You don’t know if it’s your fault for not being able to get them the care that they need.”

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