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A new citizenship requirement aimed at saving money by keeping illegal immigrants off Medicaid may be forcing eligible citizens off the federal health plan for the poor.

The requirement is part of the Federal Deficit Reduction Act passed by Congress last year. It took effect in July.

And a couple of months later, Select Health of South Carolina, which is paid a per-person rate by the state to provide managed care coverage to about 75,000 Medicaid enrollees, noticed a spike in the number of their members who were "disenrolled," said Kathy Stone, vice president of public affairs for the insurer.

The number grew from 2.5 percent in May to about 4.2 percent in October and has remained at that level since, representing a loss of 5,500 members, about 80 percent of them children, Stone said. Of 130 members the company contacted about this, about a third said they were denied because of citizenship documentation, she said.

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"They didn't have a certified copy of their birth certificate when renewal time came or they thought what they needed was a Xeroxed copy or they tried to get a certified copy of their birth certificate and couldn't and gave up," she said.

Jeff Stensland, spokesman for the state Department of Health and Human Services, which administers the Medicaid program, said the state has no data on denials attributed solely to citizenship documentation. But about 2 percent of current beneficiaries are denied because they are unable to prove citizenship or identity, and one other reason, he said.

When it comes to new applicants, about 32 percent, or 8,271 people, were denied in June, Stensland said. By September, that number was 39 percent, or 9,731 people. The denial rate has hovered around 35 percent since, he said. But the reason for the increase is unclear.

"There could be a host of reasons," he said. "One of major reasons is they just didn't fill out all the forms. Everything from that to they were over the income limit and now the new citizenship requirement. And it could be that some new applicants won't bother to get the documents until they need the care."

Susan Berkowitz, director of the South Carolina Appleseed Legal Justice Center, which advocates for low-income people, said it's unlikely people are suddenly being denied because of income.

"We're finding uninsured rates going up and per capita income going down," she said, "so it's not like we can say people are making more money so they're now disenrolled."

Other reasons for the lower numbers, she said, could be lack of transportation or childcare to apply, an inability to leave work to apply, and the cost of obtaining the documentation.

"If you're a mom with three kids who came here from Georgia, and they're requiring three birth certificates that on average cost about $12 each, and you've lost your job because the plant closed, it could be a hardship," she said.

Still, Cheryl McWilliams, a Medicaid program coordinator, said caseworkers aren't reporting denials based on citizenship documentation in significant numbers.

"We are required to verify citizenship and identity and to have a face-to-face verification of that information," she said. "But someone needing additional time to get that information, as long as they're making a good-faith effort, they will continue to receive Medicaid."

The state helps applicants born in South Carolina verify citizenship, McWilliams said, and anyone denied on the basis of documentation should ask to speak with a supervisor.

Meanwhile, the Center on Budget and Policy Priorities in Washington, D.C., says Medicaid enrollment has declined in several states since the new requirement took effect. And some states code the reason for denial, said Donna Cohen Ross, director of outreach for the center, which researches and analyzes government programs.

In Wisconsin, for instance, 8,800 eligible people were denied because of citizenship documentation between August and October, she said.

In Kansas, 14,000 of about 18,000 who lost eligibility were placed in a "pending" category because they lacked citizenship or identity documents, and they showed up as declined enrollment, she said. Virginia, which never ends a month with more than 50 in the pending category, reported 2,600 in that group in September, she said.

U.S. Sen. Jim DeMint said the problem isn't with the law, it's with getting documentation.

"To suggest that we allow anyone to get government benefits without proof of citizenship is very irresponsible. On the other hand, I would want to make sure no American citizen was denied benefits because they lost or could not afford documentation," he said.

"I would support anything we can do to help American citizens get the documentation they need. We need to solve the real problem and not make matters worse by giving government benefits to people who are here illegally."

But Cohen Ross said there is no evidence that illegal immigrants ever were on Medicaid. Plus states are reporting new administrative costs because of the requirement, she said.

Stensland said most services provided for illegal immigrants by Medicaid are emergency room costs, as required by federal law, and then mainly births. He said that since the law took effect, the average application processing time grew from 17.5 days to 22, and the average number of applications pending jumped from 10,000 to 15,000.

And so far, he said, South Carolina has spent at least $220,000 on 50 temporary employees to handle the additional work, and on ads, mailings and other outreach to inform beneficiaries of the new law.

The department has asked the General Assembly for $500,000 to help defray these costs, and any funding approved by the state will be matched by the federal government, he said.