Federal Legislation Needed to Ensure Medicaid Patients are Not Discriminated Against

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I am introducing legislation in the U.S. Senate to repeal a provision in the Deficit Reduction Act that will require people applying or reapplying for Medicaid to verify their citizenship with a U.S. passport or birth certificate. I thank my cosponsors, Senators Obama, Bingaman, Inouye, Lautenberg, Jeffords, Kerry, and Lieberman for their support.

This provision must be repealed before it goes into effect July 1, 2006, because it will create barriers to health care, is unnecessary, and will be an administrative burden to implement. The Center on Budget and Policy Priorities estimates that more than 51 million individuals in this country would be burdened by having to produce additional documentation. In 16 states, Arizona, California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, and Washington, more than a million Medicaid beneficiaries will be required to submit the additional documents to receive or stay on Medicaid. In Hawaii, an estimated 392,000 people who are enrolled in Medicaid will be required to produce the additional documentation.


The requirements will disproportionately impact low-income, racial and ethnic minorities, indigenous people, and individuals born in rural areas without access to hospitals. Due to discriminatory hospital admission policies, a significant number of African-Americans were prevented from being born in hospitals. One in five African-Americans born during 1939-1940 do not have birth certificates.

We need to ensure that Medicaid beneficiaries are not discriminated against and do not lose access to care, simply because they do not have a passport or birth certificate. Data from a survey commissioned by the Center on Budget and Policy Priorities is helpful in trying to determine the impact of the legislation. One in 12 U.S. born adults, who earn incomes less than $25,000, report they do not have a U.S. passport or birth certificate in their possession. Also, more than 10 percent of U.S.-born parents, who have incomes below $25,000, do not have a birth certificate or passport for at least one of their children. An estimated 3.2 to 4.6 million U.S. born citizens may have their Medicaid coverage threatened simply because they do not have a passport or birth certificate readily available.

Some groups are at a greater risk for losing their Medicaid coverage. Nine percent of African-American adults reported they did not have the needed documents. Seven percent of people over 65 also report that they do not have birth certificates. Many others will also have difficulty in securing these documents such as Native Americans born in home settings, Hurricane Katrina survivors, and homeless individuals.

It is difficult enough to get access to health care, let alone acquire a birth certificate or a passport before seeking treatment. Some beneficiaries may not be able to afford the financial cost or time investment associated with obtaining a birth certificate or passport. The Hawaii Department of Health charges $10 for duplicate birth certificates. The costs vary by state and can be as much as $23 to get a birth certificate or $87 to $97 for a passport. Taking the time and obtaining the necessary transportation to acquire the birth certificate or a passport, particularly in rural areas where public transportation may not exist, creates a hardship for Medicaid beneficiaries. Failure to produce the documents quickly may result in a loss of Medicaid eligibility.

Further compounding the hardship is the failure to provide an exemption for individuals suffering from mental or physical disabilities from the new requirements. I am afraid that those suffering from diseases such as Alzheimer’s may lose their Medicaid coverage because they may not have or be able to easily obtain a passport or birth certificate.

It is likely these documentation requirements will prevent beneficiaries who are otherwise eligible for Medicaid to enroll in the program. This will result in more uninsured Americans, an increased burden on our healthcare providers, and the delay of treatment for needed health care.

The hardships that will be imposed are unnecessary due to existing requirements that check immigration status. A 2005 study by the Health and Human Services Office of the Inspector General concluded there is no substantial evidence indicating that illegal immigrants claiming to be U.S. citizens are successfully enrolling in Medicaid.

Twenty-eight of 47 Medicaid directors, surveyed by the Health and Human Services Inspector General, indicated that requiring documentary evidence of citizenship would delay eligibility determination. Twenty-five believe that providing additional evidence would result in increased eligibility personnel costs. State Medicaid Agencies would likely have to hire additional personnel to handle the increased workload with significant, additional administrative and financial costs. Twenty-one believe that it would be burdensome or expensive for applicants to obtain a birth certificate or other documentation.

In my home state, the Hawaii Primary Care Association estimates the administrative costs for our Department of Human Services will result in an increased cost of $640,000. Mr. John McComas, the Chief Executive Officer, of AlohaCare, stated, “We anticipate that there will be significant administrative costs added to our already overburdened Medicaid programs. These provisions are absolutely unnecessary and place an undue burden on the Medicaid beneficiary, to our entire Medicaid program, and ultimately to our entire state.”

I am frequently frustrated by the inability of the Congress to enact measures to improve health care for Americans. A misconceived provision to mandate these additional documentation requirements will cause real people real pain, and create public health and administrative difficulties. The provision in the Deficit Reduction Act will force every current and future Medicaid beneficiary to produce a passport or birth certificate. I look forward to my colleagues working with me to repeal this provision. I am hopeful that as my friends in the Senate go home during recess, they talk with their constituents at health centers, state Medicaid offices, and social service organizations, and hear how important it is to them for this legislation to be enacted to protect access to Medicaid.

I ask unanimous consent that the full text of the bill be printed in the Record. Also, I ask unanimous consent that letters of support and concern from AlohaCare, the Association of Asian Pacific Community Health Organizations, Maternal and Child Health Access, the Hawaii Primary Care Association, and Siren be included in the record.

”’U.S. Senator Daniel Akaka is a Democrat representing Hawaii.”’

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