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Medi-Cal to require ID, proof of citizenship for many

Draft rules complying with federal law will cover 1.7 million clients plus all new applicants.

February 17, 2007|Mary Engel | Times Staff Writer

At least 1.7 million Medi-Cal enrollees and all new applicants will have to show proof of citizenship and identity to renew or receive benefits under draft regulations developed by California health officials to meet a new federal law.

State officials have worked for months to minimize the chances that eligible Medi-Cal enrollees will be dropped from the program, which provides health coverage to the state's poor and disabled people.

But healthcare advocates fear that the new federal requirements will drive away many who qualify. That, they say, could reverse a decade of efforts to simplify enrollment and may add to the strain on hospital emergency rooms, the last refuge for the uninsured.

"We've made so much progress with getting people enrolled," said Barbara Masters, public policy director for the California Endowment, a private health foundation. "This requirement is potentially going to take us two steps back."

Surveys show that more Californians are eligible for the program than enroll in Medi-Cal, the state's name for its Medicaid agency. In 2005, UCLA's Center for Health Policy Research estimated that of 763,000 California children without insurance, 247,000 -- or 32% -- would qualify for Medi-Cal but were not enrolled.

Except for emergencies and some other cases, the government insurance program has always been limited to U.S. citizens. But verification has been fairly simple. Many states required that Medicaid applicants sign a letter, under penalty of perjury, attesting to their citizenship; California verified enrollees' Social Security numbers with the federal government.

The law's congressional sponsors said it would save the federal government money by eliminating immigrants who lied about their citizenship status to claim nonemergency Medicaid benefits. Federal and state officials have said there was no evidence of widespread fraud.

California has trailed other states in implementing the new law, which was signed by President Bush last February and took effect July 1. The state's final draft regulations went out to county social services agencies last week. Public comment on the regulations will end Thursday. The state has not set a date for releasing the final rules.

There are 6.5 million Medi-Cal recipients in California. But not as many people are going to be affected by the law as had originally been thought.

In December, Congress exempted those in foster care, on Medicare and on Social Security disability from the verification requirements -- about 3 million people in California.

Moreover, by programming its computers to match Medi-Cal data with birth records, the state has been able to automatically verify the citizenship of about half the remaining 3.5 million enrollees, said Stan Rosenstein, deputy director of medical care services in the California Department of Health Services. (Adults still would have to prove their identity.)

"We've done what we can under federal law to streamline the process," Rosenstein said.

That leaves about 1.7 million people who must prove their eligibility with citizenship and identification documents such as birth certificates, passports or driver's licenses.

Future enrollees from other states also must present such evidence.

Because hospitals report births to the state electronically, newborn infants of mothers on Medi-Cal -- including the citizen-newborns of undocumented mothers -- will continue to be automatically enrolled.

The Center on Budget and Policy Priorities, a nonpartisan research group in Washington, D.C., released a study Feb. 2 of six states that began enforcing the new law last July. All six -- Wisconsin, Kansas, Iowa, Louisiana, Virginia and New Hampshire -- saw enrollments decline and administrative costs rise.

In some states, it took applicants months to gather birth and other documents, center outreach director Donna Cohen Ross said. In others, even recipients and applicants whose citizenship had been verified by computerized records lost benefits because they failed to document their identity.

Cohen blamed the problem on the law's requirement that documents be originals, not copies.

"I have my original driver's license," Cohen said. "If I mail it to you, how am I going to drive? The other alternative is to go in person to the Medicaid office. If I'm working at a low-income job, chances are it's very hard to leave my job during the day."

Los Angeles County plans to set up stations in lobbies to quickly scan and return documents to applicants, said Eileen Kelly, division chief in charge of Medi-Cal for the county's Department of Public Social Services. Medi-Cal offices will open one Saturday a month, and enrollees will be able to go to whichever office is closest to their home or work site.

The state has promised to cover the excess staffing and data-entry costs.

"States and counties have to expend a large amount of money to administer this program," said Masters of the California Endowment. "Families have to expend a lot of money to get these documents. All to do something that nobody had identified as a problem."

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