New Citizenship Requirements Hurt U.S. Citizens, Not Immigrants

By John Bouman

The national debate on immigration policy is revealing some nasty unintended consequences.  Congress has taken action with the intent of keeping undocumented immigrants off Medicaid rolls, but the ironic result is that U.S. citizens across the country are losing their health care.  Last week, the Centers for Medicare and Medicaid Services published final citizenship documentation rules for the Medicaid program.  Under these rules, individuals now must show a passport, original birth certificate or similar difficult-to-obtain form of identification to secure health care.  The final rules do not repair, but perpetuate, the perverse outcome of the documentation requirement – eligible people losing health care coverage.

According to a recent GAO report, the citizenship documentation requirement has led to widespread declines in Medicaid enrollment and increased administrative costs for states.  What is it particularly troubling is that a Center on Budget and Policy Priorities (CBPP) study suggests that the decrease almost entirely reflects difficulties that American citizens are encountering in obtaining birth certificates or passports.  In New Mexico, a woman with diabetes was terminated from her Medicaid when she couldn’t produce her original birth certificate.  Her abusive former boyfriend had ripped up the certificate and thrown it away.  Lacking financial resources to travel to her hometown of El Paso, Texas to search for her records, she went without needed care.  By all accounts, this is a typical consequence of the citizenship documentation requirement on low-income Americans in need of health care.

Even when Congress enacted the provision last year, there was no evidence that undocumented immigrants were enrolling in Medicaid as citizens.  It comes as no surprise, then, that states have since uncovered only a handful of cases where someone receiving Medicaid had incorrectly claimed to be a U.S. citizen. In ferreting out these isolated cases, states were forced to deny or delay coverage to thousands of citizens who did not have easy access to original birth certificates or passports.  They have also wasted significant government resources.  The U.S. House of Representatives Committee on Oversight and Government Reform recently found that for every $100 spent by the federal government to implement the citizenship documentation requirement, only 14 cents in Medicaid savings were realized.  As a consensus builds in America that we fix the health coverage crisis, here is a policy that sends us reeling backwards, terminating and denying coverage to eligible people who need the coverage the most.  

The Social Security Administration for years has had a reasonable approach that protects against incorrect citizenship claims while also achieving the main goal of delivering benefits to those who are eligible.  It is possible to achieve both goals.  The new Medicaid documentation rules are unreasonable and expensive, disrespect state processes, and fail to accomplish the goal of providing needed health care to people Congress made eligible.