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Effort to Delay New Medicaid Citizenship Requirements Blocked

By Mary Agnes Carey, CQ HealthBeat Associate Editor

June 29, 2006 -- Senate GOP leaders objected Thursday to a unanimous consent request to pass legislation that would delay new Medicaid U.S. citizenship verification requirements set to begin July 1.

Sen. Daniel K. Akaka, D-Hawaii, sponsor of the measure (S 3590) that would delay the implementation of those requirements until Jan. 31, 2007, said he did not know which Republicans objected to his bill. "I don't know what their reasons are," Akaka said. A Senate GOP aide said Thursday the measure was blocked because members had not yet had a chance to review it or see a Congressional Budget Office score of its financial impact. The bill also had not undergone committee consideration, the aide said.

Akaka, other lawmakers and consumer and health groups say the new requirements, which will take effect Saturday, could cause three to five million Medicaid beneficiaries to lose their eligibility because they cannot produce the documents required, such as birth certificates or passports.

The American Hospital Association, the Federation of American Hospitals and other hospital groups Thursday wrote to Department of Health and Human Services Secretary Michael O. Leavitt to express concern that the new requirements "could mean that eligible U.S. citizens and nationals will lose Medicaid coverage."

Advocates for the poor Wednesday filed a class action suit to block the provisions, which were included in the budget savings bill (PL 109-171) President Bush signed into law in February. Centers for Medicare and Medicaid spokeswoman Mary Kahn declined comment Wednesday on the suit but said "states must afford applicants or current enrollees a reasonable opportunity to secure the required documents. If a beneficiary is having difficulty, we have instructed states to assist the beneficiary."

Speakers at a news conference Thursday said the new Medicaid requirements will be difficult for many people, including residents of nursing homes, individuals with mental and physical disabilities, or children in foster care, who may not have the required documentation. Children taken from troubled homes, for example, often come into foster care with little more than a few clothes and perhaps a favorite toy, said Linda Spears, vice president for communications at the Child Welfare League of America.

"Social workers, parents, no one is thinking, 'Where's the passport? Where's the birth certificate?'" Spears said.

Aware of the difficulties the new requirements will impose, some states, such as Maine, chose to delay enforcement of the new requirements, said Dan Hawkins, vice president for federal, state and public affairs for the National Association of Community Health Centers. Ohio officials also announced they will delay implementation of the new requirements until Oct. 1.

Implementing the new requirements will also be expensive for states. In January, the Hawai'i Primary Care Association estimated it would cost $640,000 yearly to put the new regulations into place.

A "technical corrections" bill has been drafted, but not yet introduced, to alter the Medicaid documentation changes, although opponents of the changes said the legislation does not go far enough. Action on that measure could come after the July Fourth recess.

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