Reprinted, by permission, from HFMA News, October 28, 2008. Copyright 2008 by the HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION.

Medicaid documentation requirements enacted by Congress in 2006 continue to present serious, ongoing problems for health centers and their patients, according to a new analysis issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at The George Washington University School of Public Health and Health Services. This study is the second in a two-part study that looks at the effects of the Medicaid citizenship documentation requirements contained in the Deficit Reduction Act (DRA). The first survey, conducted in 2006, found that the DRA requirements adversely affected eligible patients in nine out of 10 health centers.

Community health centers are the largest source of comprehensive primary care for low-income patients. In 2007, health centers served more than 16 million patients at over 6,200 sites nationwide, including more than 5.6 million Medicaid beneficiaries and 5.8 million low-income children. The study found that documentation requirements appear to have particularly affected access for several specific patient categories, including U.S.-born newborns, whose need for rapid management can become a particularly acute matter. Most troubling, the authors found that despite the fact that the DRA documentation requirements do not apply to State Children’s Health Insurance Programs (SCHIP) when administered as a separate program, one-third of health centers located in states with separate SCHIP programs reported that citizenship documentation requirements are being applied to SCHIP applicants.

“This study reinforces our earlier findings regarding the damage done by the law, not only to individual patients and healthcare providers but to the overall quality of care,” said Sara Rosenbaum, JD, Hirsh Professor and chair, SPHHS Health Policy Department and a study co-author.