Show Us Your Papers!
Put forth on June 21, 2006 by XicanoPwr
Posted in Health Care, Immigration, Immigration Debate, Medicaid, Raza
Beginning next month, all US citizens applying for Medicaid or renewing their Medicaid eligibility will have to prove their citizenship by presenting a U.S. passport or the combination of a U.S. birth certificate and an identification document. Individuals who cannot do so will be denied health services financed with federal Medicaid funds. It seems Dudya and Congress pulled another fast one. According to the NY Times:
The Bush administration plans … to issue strict standards requiring more than 50 million low-income people on Medicaid to prove they are United States citizens by showing passports or birth certificates and a limited number of other documents.
The requirements, which take effect July 1, carry out a law signed by President Bush on Feb. 8 [Public Law No. 109-171,§ 6037].
… The purpose of the law was to conserve federal money for citizens, reducing the need for states to cut Medicaid benefits or limit eligibility.
More than 50 million Medicaid recipients will soon have to produce birth certificates, passports or other documents to prove that they are United States citizens, and everyone who applies for coverage after June 30 will have to show similar documents under a new federal law.
The lies given by the Congressional Budget Office. They claim that 35,000 people will lose coverage by 2015. Most of them will be illegal immigrants, but some will be citizens unable to produce the necessary documents.
However, that is a plain out right lie. On June 9 the Centers for Medicare & Medicaid Services (CMS) issued a guidance to state Medicaid agencies explaining the requirement and what individuals and states must do to comply with it. The guidance makes harder on US citizens and state Medicaid agencies than is required by the DRA or needed to ensure that US citizens are in fact US citizens.
Under the terms of the guidance:
- US citizens applying for or renewing their Medicaid coverage must produce passports or birth certificates to prove their citizenship unless they can show these documents do not exist or cannot be obtained within a reasonable period of time.
- All documents provided to meet the requirement must either be originals or copies certified by the issuing agency.
- US citizens who apply for Medicaid and meet all eligibility criteria cannot receive coverage for needed health or long-term care services until they have produced the required documents proving that they are citizens. The guidance prohibits states from making coverage available while the applicant attempts to obtain a passport or birth certificate. Delaying coverage for applicants in this way is a significant departure from the draft guidance that HHS circulated in May. The draft guidance would have allowed US citizens who meet all other eligibility requirements to receive Medicaid coverage while they obtain the documents that prove their citizenship. By contrast, under the final guidance, low-income children, parents, seniors and people with disabilities who have applied for passports, copies of their birth certificates, or other documents will be denied coverage for health care services while they wait for government agencies to provide these documents.
- The documentation requirement will even apply to seniors and people with physical or mental disabilities who are Medicare beneficiaries, as well as to seniors and people with disabilities who receive SSI benefits, all of whom have already had their citizenship verified by the Social Security Administration. Many of these people may now be in a physical or mental state that makes it difficult, if not impossible, for them to produce these documents (and in some cases, even to comprehend what they are being asked to do).
- State Medicaid agencies will have to obtain documents showing that US citizen children in foster care are citizens, even though state child welfare agencies have already verified that fact in determining these children’s eligibility for federal foster care payments.
These provisions will result in delays, outright denials, and loss of coverage for many US citizens applying for Medicaid. US citizens who cannot provide “primary” documents to meet the documentation requirement must provide proof both of citizenship and of their personal identity. Using birth certificates, along with several other documents such as - final adoption decrees and official records of military service, will be considered as “secondary evidence” of citizenship.
The guidelines list four categories of documents that can be used as evidence of citizenship:
- 1st category: US passport or a certificate of naturalization;
- 2nd category: state and local birth certificates and State Department documents issued to children born abroad to United States citizens;
- 3rd category: nongovernment documents - medical records from doctors, hospitals and clinics, nursing home admission papers, and records from life and health insurance companies; and
- 4th category: affidavits, which can be used “only in rare circumstances when the state is unable to secure evidence of citizenship” from other sources.
Documents that are considered acceptable of proof of identity, such as - driver’s license; school identification card; include a picture of the individual, however, many people with disabilities do not have these documents and CMS does not make any provisions to help people with disabilities prove their identity.
According to HealthLawProf Blog the new standards will create an additional hardship and possible loss of benefits to millions of children, older Americans and poor people born at home in rural areas who never received birth certificates. HealthLawProf also explains:
Federal policy may be to deny health care benefits to undocumented immigrants, but it obviously doesn’t go so far as to require (or even permit) the denial of health care services (emergency services, at any rate) to undocument immigrants. EMTALA requires Medicare-certified hospitals to provide a medically appropriate screening for patients who come to their ER’s and to attempt to stabilize any emergency condition found to exist, and this requirement applies (as it should) regardless of the patient’s citizenship status. Tightening up Medicaid eligibility rules may (or may not) make some kind sense as a matter of immigration policy, but as a health care policy it only makes a bad situation worse — and not only for hospitals.
Examples of those who are at risk of having their Medicaid coverage terminated, denied, or delayed are:
- An elderly parent who is stricken with Alzheimer’s and resides in an assisted living residence can lose Medicaid coverage which happens to pays for their care because their birth certificate cannot be located or no longer has a driver’s license.
- A child of an incarcerated single mother may not receive Medicaid coverage for the health services because a certified birth certificate cannot be located.
- A low-income woman who is just diagnosed with breast cancer and would qualifies for Medicaid, treatment could be delayed for a number of weeks or months because she is forced to wait for a certified copy of her birth certificate.
- An elderly African American woman who was never issued a birth certificate (many elderly African Americans were born at home and never received a birth certificate because their parents did not have access to a hospital due to racial discrimination, especially if they were born in the South in the early decades of the last century) and who has no living family members who could attest to her birth in the United States may lose Medicaid coverage.
- Native Americans who could lose their coverage because “certificates of Indian blood” and other forms of tribal identification are not considered proper identifications.
Here is the irony of it all, in a quest by the Rethugs to screw the undocumented, they ended up screwing its own citizens. Since emergency health care benefits to undocumented immigrants can not be denied all they did was create a silly health care policy that only made things worse. They are so blinded by their hate, they do not see how they are clearly destroying lives and families and the very fabric of this country they claim to care about.
If you do not have insurance, you can now kiss your health care good bye.
Considering that I do get visitors from Congress, I HOPE YOU ARE READING THIS!!!!
Technorati Tags: Medicaid, CMS, HHS, undocumented immigrants, immigration policy, African Americans, discrimination
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This is the blog of Edmundo "XicanoPwr" Rocha, a social worker, an activist, freelance writer and founder and editor of The Sanctuary. My interests include: immigration reform, critical race theory and it's interaction with equality/inequality and freedom/oppression as they relate to the experiences of people of color in the Americas.
Para Justicia y Libertad is a Latino-centered political blog focusing on the humanistic perspective of politics, history, and society as they relate to the Latina/o community throughout Texas and the United States.
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8 Responses to “Show Us Your Papers!”
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Obtaining a copy of one’s birth certificate is not difficult. Really, it’s not. Not if you’re a legal resident, anyway.
My parents were both born at home, and they have valid birth certificates stating such.
It’s not the elderly US citizens who will have problems with this. It’s the elderly Mexican citizens who come to the US for free treatment who will.
I’d love to save the world, but there’s not enough of my tax dollars to go around. Harris County Texas spent over 100 million dollars in 2005 to provide medical care to illegal immigrants. That’s excluding Medicare/Medicaid or emergency room visits. It was 70 million in 2004, so let’s assume it will be 130 million in 2006.
I don’t get a free ride. Why should someone who is here illegally? If I were illegally in Mexico, they’d throw me in jail.
Another thing in your post that I take exception to.
You seem to assume that Medicaid is a right (”. . .you can kiss your health care good bye.”). It is not. Medicaid is not a substitute for getting the skills needed for a decent job so that you can pay for your own health expenses, like most working Americans have to do. Medicaid recipients should be working to better themselves, not expecting to continue to sponge off the rest of us. I wish there was a better way to phrase it, but that’s the bottom line.
Elderly people and people with special problems are the exceptions. But otherwise healthy 20 year olds should not be relying upon Medicaid nor think that it’s something they have a right to have.
Haloscan just ate my comment!
Surfer, 78% of Americans would disagree with your assertion that health care is not a right. We live in a country where 15.7% of us do not have health insurance. The percentage of Texans without health insurance is 24.8% That might be why Harris County had to spend $100 million on medical care for “illegal immigrants” (BTW where’s your source for that information? Link please) I bet a that not all of the Texans without health insurance are illegal aliens but Americans. I’d bet some are in the middle class who are one health care crisis away from losing everything.
But noooo, it would just be easier for you to build the straw illegal immigrant and tear him down with your racist statement about how illegal immigrants are the reason why our health care system is screwed up.
Thanks Phinky!
I think I know where the source of information Surfer used to get those figures, it probably came from a recent article in the Houston Chronicle. The figures used by Surfer are similar, but I wonder how s/he knows that the 100 million spent excludes Medicare/Medicaid or emergency room visits. Not even the Chronicle made that claim. So unless Sufer works for the Hospital District or Commissioner Steve Radack knows something that wasnt reported by the Chronicle, I have to agree with Phinky, provide the source of information. Otherwise, this another attempt to misstate the facts just to make things worse. Nice try, thanks for playing.
I enjoy how Houstons GOP enjoys using their bread and butter argument when it comes to the hospital district and immigration. Yes the HCHD does have many problems, and the services used by the undocumented is not the root of their problem. (I will address this issue in a future post.)
But let’s address the Chronicle’s article that is being use to show how HCHD is bleeding the Harris County taxpayer dry because of these so-called “Border Jumpers.” The HCHD is SUPPOSE to provide healthcare to more than 1.1 million people in Houston/Harris County ALONE to those who have no health insurance. This is out of a total population of 3.5 million in Houston/Harris County. The hospital district does this by operating 3 hospitals (Ben Taub General Hospital, Lyndon B. Johnson General Hospital, Quentin Mease Community Hospital); 12 community health centers; a dental center; seven school-based clinics; 13 homeless shelter clinics; and four mobile health units.
As I stated, this is just for residents of Houston/Harris County. In the ideal world this would be great, but in reality, it doesnt. HCHD this does not, HCHD a “regional health care system therefore services are provided to surrounding counties, which was not brought up by the Chronicle. Even Harris County’s Judge Robert Eckels will attest to that fact. In fact, we will on his website, he states that the hospital district has become a “regional health care system for the adjacent counties, the southern United States, and other countries.” Houston being a mini United Nations, other countries does not mean those countries South of the Border. Since Ben Taub hospital is consider one of the top hospitals in the nation for Trauma patients are brought in from surrounding regions. I also find it interesting that the Chronicle or the HCHD report didnt talk about Hurricanes Katrina and Rita evacuees and the cost to the hospital district. Where they reimbursed for that too?
Should we spend local taxpayer money to secure Harris’ County’s borders so we deny any non-Houston/Harris County residents from surrounding counties from using our healthcare services because their own county has fewer services.
Texas leads the nation in the percentage of uninsured adults, and the percentage and number of uninsured children because of TX’s stringent qualifications for eligibility for state and federal programs (Medicaid and the State Childrens Health Insurance Program - SCHIP), I guess those elderly don’t really have to worry about showing proof of citizenship.
You really should pause for thought before you post. Please, where in my posts did I say anything about anyone’s race? Yet you scream “racist.” Calm down a bit and maybe you’ll learn something. Maybe if you’re calm you’ll be more effective in sharing your views with me, too. There’s enough heat on these problems already.
First, combining this country’s lack of overall heath care for citizens with the illegal immigration issue simply muddies the waters. Yes, our current heathcare system is a mess and needs to be fixed. The government has been grappling with that problem for years and there’s no solution in sight yet.
For the existing system, what this new law does is ensures that taxpayer dollars are not being spent on citizens of another nation. You yourself have acknowledged that we aren’t able to serve the citizenry now. So a prudent government takes steps to ensure that funds are being directed to citizens. When the amount being spent on illegal immigrants (or residents of other counties, Katrina evacuees, visitors, etc.) was not a significant portion of total expenses, they were not so concerned. If you are immigrants or children of recent immigrants, you know full well that Mexican citizens who could get care in Mexico choose to come to the US for care because it’s free. Be honest.
(BTW, Houston and Harris County are continuing negotiations with both the State of Louisiana and the Federal Goverment regarding reimbursements for Katrina evacuees, not just for heath care, but for housing and education too.)
Do you really think that bankrupting the current system by providing care to non-citizens will somehow force the goverment to address the bigger issue of lack of an adequate heathcare system? It won’t. It will simply force them to shut down what systems there are.
What amazes me about much of what I hear from the pro-illegal side of this issue is the assumption that there is enough money around to pay for this kind of stuff. Do the words deficit and federal debt have no meaning for you? Do you understand the federal budgeting process? THERE IS NO MONEY and no amount of demonstrations or walkouts or screams of racism or whatever will change that cold hard fact. Folks here who think things should be changed have been working to change them for a very long time.
As far as emergency room care being excluded, if you do some basic research on this you will discover that unpaid emergency room care is generally reimbured via the Medicare system or through block grants, both federal systems, not via the Harris County system. The website below has several papers on the topic, including this most recent one on emergency care in the US: http://www.nap.edu/catalog/11629.html
I think it’s good that this website is attempting to take part in the discussions on this divisive issue, but please, tone down the rhetoric and try to grasp a bit more of the bigger picture. Good luck. It’s nice to see folks
Got truncated
…involved in the process.
Surfer | 06.23.06 - 8:57 am | #
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