A new federal law designed to prevent illegal immigrants from getting Medicaid is more likely to create problems for poor U.S. citizens, a nonpartisan think-tank has concluded.

The law requires that Medicaid beneficiaries document their citizenship or immigration status beginning next month as part of the Federal Deficit Reduction Act signed by Congress in February.

At any time, there are about 850,000 people on Medicaid in South Carolina and about 1 million over the course of a year, said Jeff Stensland, spokesman for the state Department of Health and Human Services, which administers the program.

And while the law was aimed at undocumented immigrants, the Center on Budget and Policy Priorities says U.S. citizens are most likely to be affected -- particularly the elderly, nursing home residents, the disabled, the homeless, the mentally ill, those who've lost everything in fires or disasters like Hurricane Katrina.

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Also affected will be black people and rural residents who've never had a birth certificate or passport, and those with a sudden medical emergency, the group says.

But U.S. Sen. Jim DeMint, R-Greenville, who voted for the measure along with Sen. Lindsey Graham, said something needed to be done.

"Medicaid is the fastest growing expense for most states and is unsustainable the way it is now," he said.

"We're at the point every year now of trimming back Medicaid benefits for people in South Carolina because we don't have enough money. It doesn't make sense to add people to the roles who aren't here legally."

Donna Cohen Ross, director of outreach for the center, which researches and analyzes government programs, says the documentation requirement was based on a faulty idea.

"The premise was that there are undocumented immigrants who are falsely claiming to be citizens getting onto the Medicaid program," she said. "But the Office of the Inspector General investigated in 2005 and found there was no evidence of a problem."

So now U.S. citizens will have to produce paperwork that some may not have access to and many will not have easy access to, she said.

"And the result is that eligible U.S. citizens are likely to have their Medicaid coverage delayed, denied or terminated if they can't provide this documentation," she said.

A survey conducted for the center found that 8 percent of U.S.-born adults with incomes below $25,000 don't have a U.S. passport or U.S. birth certificate, and one in 10 didn't have such a document for at least one child, including 9 percent of blacks.

Extrapolating these numbers, the center reports that up to 4.6 million citizens could face eligibility difficulties because they have no documentation at hand.

DeMint said eligible citizens should have access to the program and that problems with documentation should be worked out. And Stensland said the department will help those who have difficulty finding documentation.

"It does need to be handled, and it's very important that we keep our promises to American citizens," DeMint said. "But we don't want to create more incentives for illegals to be here, and we have to make sure we don't sign them up for social programs they're not entitled to."

Ironically, federal law also requires that hospital emergency rooms treat anyone regardless of their status, including illegal immigrants, and hospitals receive reimbursements from Medicaid for that care. Stensland said Medicaid has paid for $9.9 million worth of hospital emergency room charges for illegal immigrants in South Carolina since last July.

And that ultimately affects the overall price tag for health care because the cost of uncompensated care is shared by paying patients and taxpayers, said Suzie Foley, executive director of the Greenville Free Medical Clinic, where health care providers volunteer their services to care for uninsured residents.

DeMint agreed that lots of people, even those legitimately on Medicaid, show up in ERs when they shouldn't. But the new requirement is "one way to begin to identify illegals and create some rationale in the immigration system," he said, adding that more than half the calls to his office for the past three months have been about illegal immigration.

The center also says that in the first year states will have to check on more than 50 million beneficiaries, including 49 million U.S.-born citizens, generating higher administrative costs for local governments, hospitals and nursing homes.

Getting copies of birth certificates can take time, the center adds, and the costs also can be prohibitive for low-income people.

The Kaiser Family Foundation, meanwhile, reports that an estimated 35,000 beneficiaries nationwide could be expected to lose coverage because of the new requirement, according to spokesman Rakesh Singh.

Kaiser reported last week that Medicaid spending and enrollment growth has slowed in recent years.

Spending growth on medical services fell from 12.9 percent to 7.4 percent between 2000-2002 to 2003-2004, Kaiser reports, while growth in enrollment slowed from an average of 9 percent to 4.1 percent over the same time frame.

Kaiser attributes the changes to an improved economy and "aggressive Medicaid cost containment policies that have been adopted by states in recent years."

Nonetheless, Kaiser says about 75 percent of the growth can be traced to higher health care prices and increased enrollment, which is fueled by drops in employer-sponsored insurance.

"As federal and state policy-makers explore options to better manage Medicaid spending," the report's authors wrote, "it will be important to assess the impact future reforms may have on the health of Medicaid enrollees, their access to providers, and the number of uninsured Americans."