Reproduced with permission from BNA’s Health Care Daily Report, No. 207 (Oct. 27, 2008).

Copyright 2008 by The Bureau of National Affairs, Inc. (800-372-1033)

Citizenship documentation requirements for Medicaid beneficiaries have negatively affected patients at most community health centers, and the policies have been improperly applied to some enrolled in the State Children’s Health Insurance Program, according to a report released Oct. 21 by the George Washington University School of Public Health and Health Services.

The report, conducted by the Geiger Gibson/RCHN Community Health

Foundation Research Collaborative, found that 73 percent of community health centers have experienced problems with the documentation requirements for at least one Medicaid patient group.

In addition, although the requirements do not apply to states that administer their SCHIP programs separately from Medicaid, 34 percent of health centers surveyed in such states reported that SCHIP applicants are being asked to document their citizenship.

The requirements were enacted as part of the Deficit Reduction Act, which took effect in 2006, and were finalized in 2007.

“Although the intent of the statute was to prevent persons who are not legal U.S. residents or citizens from receiving Medicaid, the evidence suggests that the law has had only a limited effect on non-citizens and that the thrust of its impact has been on low income citizens and the health care providers that serve them,” according to the report.

Access Difficulties.

The report found that parents, new patients, pregnant women, children, and newborns all are negatively affected by the requirements, and the results indicate the problems have intensified since a similar study was completed in 2006.

For example, 30 percent of health centers reported problems for parents in 2006, compared with 40 percent in 2007. In addition, the percentage of centers reporting trouble for newborns only decreased from 13 percent to 10 percent even though newborns were excluded from meeting the requirements in the final rule.

The report found that nearly half of health centers reported that Medicaid patients face longer application and enrollment times, as well as problems acquiring documents, which in turn affect health centers’ ability to refer patients to specialty care, begin services for new patients, and secure supplies and equipment, including prescription drugs.

The report also found that despite Medicaid delays and disruptions, most patients remain eligible for care because of the safety net role health centers play. “As a result, the delay and disruption in Medicaid coverage for uninsured but Medicaid-eligible patients had a spillover effect, depriving health centers of funding that otherwise would have been used to maintain or increase care for other uninsured but Medicaid-ineligible patients in their service areas,” according to the report.

The report, Assessing the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients: Results of a “Second Wave” Survey, is available here.