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U.S. citizenship required for Medicaid

Mandatory documentation may hurt many state residents

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More than 850,000 South Carolinians must prove they are U.S. citizens or risk losing their health insurance under a new Medicaid requirement that takes effect July 1.

State health administrators, nursing homes and others are worried that perhaps thousands of eligible residents will lose coverage under the state's version of Medicaid or be unable to enroll in the program because they lack the required documentation.

The new federal law, part of the Deficit Reduction Act signed into law Feb. 8 by President Bush, aims to ensure that illegal immigrants don't receive Medicaid benefits. The law will require a passport, birth certificate or other proof of citizenship for enrollment.

But there's concern that it will cause problems for others -- including children, elderly people in rural areas and nursing home residents -- who are unable to produce such documents.

"It will cause some hardships for people that have been here their whole life that live in rural areas," said Tommy Cockrell, vice president of the South Carolina Hospital Association. "Some of these people might not even have birth certificates, and certainly, the majority don't have passports."

Members of the hospital association and state health administrators also are concerned about the homeless, those whose records have been lost or destroyed, and people with dementia.

"We will have safety nets in place, but we expect there to be some issues," said Jeff Stensland, spokesman of the South Carolina Department of Health and Human Services, the agency that administers the state's Medicaid program.

Now, South Carolina beneficiaries are required to produce only a Social Security number and proof of residence in the state in the form of a driver's license or a utility bill listing the person's name and address.

"Our intent is to not take people off the rolls of eligibility," Stensland said. "We don't want people that would be eligible to have a gap in coverage because they can't locate these documents, but at the same time, we intend to enforce the law."

The agency began sending letters to Medicaid beneficiaries last week that urge them to be prepared to produce proof of citizenship when re-enrolling in the program.

Medicaid is a federal program that partners with states to provide health coverage and long-term-care assistance to 39 million people in low-income families and to 12 million elderly and disabled people. The program also helps fill in gaps in Medicare coverage and reimburses hospitals and other health-care providers who serve those patients.

Nearly one-quarter of South Carolina residents are eligible for Medicaid. They must re-enroll at least once a year, primarily to determine income eligibility. Stensland said the state is fortunate that enrollment periods are rolling and staggered so that not every beneficiary must sign up at once.

Still, hospitals are worried that the new law will increase the percentage of patients who come to the emergency room without any insurance, said Cockrell of the hospital association.

"The access (for uninsured patients) will still be there, but it will be quite a burden on the hospital and the patient," he said. "Any time you make a change like this, it's going to create a strain."

Nursing homes are worried that the new law would slow the Medicaid approval process.

"Our major concern is that this new eligibility process will take longer than it did before," said Randy Lee, president of the South Carolina Health Care Association, which represents about 90 percent of the state's nursing homes.

If the process drags on for weeks and the patient doesn't end up qualifying for the program, the nursing homes are stuck with the patient's bill.

"Nursing homes can write off bad debt to a degree," Lee said, "but in the end, facilities end up eating a major portion of the bill." It could become a major problem for some low-income nursing homes that operate on tight budgets.

Contact Peter Frost at 706-8169 or . To comment on this story, please go to islandpacket.com.