A special Blog post from our Director of Administrative Advocacy, Beth Abbott:
I attended a forum on Thursday to evaluate the effectiveness of requiring applicants and current beneficiaries to prove their U.S. citizenship and identity to receive Medicaid (Medi-Cal in California) under the federal Deficit Reduction Act. The U.S. Congress, operating on the speculation that many illegal immigrants in the U.S. were claiming to be citizens to become eligible for Medi-Cal, proposed this provision into the eligibility requirements for Medicaid for all states in 2005.
The Government Accountability Office (GAO) did a study to evaluate that premise. Their study found no evidence to support that undocumented people falsely asserted that they were citizens, and there was no basis for establishing a requirement to prove citizenship or identity when applying for Medicaid. Congress was undeterred and inserted this provision in the law affecting all states effective July 1, 2006.
This forum in Sacramento showcased the experience of California’s Department of Health Care Services (who lay out the rules for Medi-Cal in California), California counties (who implement these new rules throughout the state), as well as the experience of other states, foundations, and public policy institutes.
The Good: Our state and counties were consistently complimented about their thoughtful and even-handed implementation of this onerous law. California sought input from a wide variety of stakeholders to minimize the harm of these requirements, communicate as clearly as possible about the complexities of the law, and build into the state rules as much flexibility as they were able to get.
The Bad: California and the counties said:
• They had not uncovered any fraudulent attempts to claim U.S. citizenship.
• The state admitted that so far they had spent about $80 million dollars to implement this new law. (This is serious money!)
• The counties had not included the costs to pay for training, longer interviews, additional computer coding or file documentation, or help obtaining proofs.
• Although this law affects only U.S. citizens, it has had a chilling effect and these additional administrative hurdles discourage applicants.
The Ugly: Based on the first two years of its implementation, many attendees believed this was evidence of a misguided, but costly attempt to deal with U.S. immigration problems through the back door, to the detriment of our citizens. However, if this early experience were not enough, Congress is considering expanding this requirement to such programs as Healthy Families, CAL-Works, and others. The consensus was that these requirements did nothing to contribute to the expansion of public health programs, streamline efficiency of the administration of government programs, or add meaningful deterrents to fraud or abuse in public benefits.