By Mary Agnes Carey, CQ HealthBeat Associate Editor

Medicaid documentation requirements Congress approved last year have caused a nationwide disruption in Medicaid coverage for health center patients, with more than 90 percent of all health centers reporting enrollment difficulties for patients of all ages, including newborn children, according to an analysis released Monday.

Between 2.2 percent and 6.7 percent of all Medicaid enrolled patients have lost coverage for some period of time due to the new documentation requirements, an estimate the study’s authors described as extremely conservative and not taking into account the impact of the changes on newborn children or new applicants. Between 105,100 and 319,500 Medicaid patients, including up to 212,400 children and 107,100 adults, are expected to be affected, with the disruptions in Medicaid coverage for currently enrolled patients expected to cost health centers between $28 million and $85 million, the study estimates.

The report released Monday was prepared by The George Washington University School of Public Health and Health Services and funded by the RCHN Community Health Foundation, a New York-based not-for-profit foundation supporting community health centers. The study examines the impact of Medicaid documentation requirements included in budget-savings legislation (PL 109-171) that President Bush signed into law last year.
Medicaid accounts for 37 percent of all operating revenues for health centers, which describe themselves as the largest source of comprehensive primary care for low-income patients.
Centers for Medicare and Medicaid Services (CMS) spokeswoman Mary Kahn said that CMS “cannot substantiate the claims in the study as we have not gotten any supporting data from the states.” She added that CMS has “worked cooperatively with partners and interest groups in writing regulations that give states as much flexibility as possible under a fairly proscriptive piece of legislation” and that states have been instructed to help individuals having problems obtaining items such as birth records.
Provisions of the law require Medicaid beneficiaries to produce documents such as a birth certificate or passport to prove they are U.S. citizens. Some lawmakers, consumer and patient groups have said the new requirements, which went into effect July 1, 2006, could cause millions of Medicaid beneficiaries — in particular residents of nursing homes, individuals with mental and physical disabilities or children in foster care — to lose their eligibility because they will not be able to produce such documents.
The study found that more than 43 percent of health centers report that patients are experiencing problems such as longer enrollment and application processes, the lack of appropriate documentation or having to pay to get necessary documents.

One-third of health centers report having to increase staff time to help patients with the enrollment process, according to the study, and enrollment delays and disruptions are affecting the ability of almost half of reporting health centers to arrange for specialty care. In addition, 38 percent report difficulties in securing health care access for new patients and 28 percent report problems with pre-arranging hospital inpatient deliveries for pregnant women.

Source: CQ HealthBeat News Same-day coverage of the people and events shaping health care policy from Washington. © 2007 Congressional Quarterly Inc. All Rights Reserved.