California To Delay Enforcement Of Federal Rule Requiring Proof Of Citizenship For Medicaid Eligibility

California health officials on Tuesday said they are postponing the enforcement of a new federal law that will require Medicaid enrollees and applicants to show proof of U.S. citizenship, the Los Angeles Times reports (Lin, Los Angeles Times, 6/7). Under the measure, signed into law by President Bush in February, individuals seeking care through Medicaid as of July 1 will be required to show proof of U.S. citizenship — such as a birth certificate, passport or another form of identification. The law’s intent is to prevent undocumented immigrants from claiming to be citizens in order to receive benefits provided only to legal residents (Kaiser Daily Health Policy Report, 6/5). An estimated 650,000 of seven million beneficiaries of Medi-Cal — the state’s Medicaid program — might not have the proper documentation to prove citizenship, according to the California Budget Project. California officials decided to delay enforcement of the new rule because HHS has not released federal guidelines, which are still under revision. Stan Rosenstein, deputy director of medical care services in the California Department of Health Services, said that because the guidelines have not been released, the state has not had time to establish plans for counties, prepare workers and inform Medi-Cal patients about the new requirement. Rosenstein added that until the state enforces the rule, neither patients nor physicians will be reprimanded if documentation is not provided. When the state obtains federal guidance on the rule, which might come this week, California likely will draft and issue rules for county social service agencies by midsummer, according to Rosenstein. The new rules will be implemented after the state and county government can inform enrollees of the new requirements, he said. The state’s decision to delay enforcement of the new rule could contradict federal law, but it is uncertain whether federal officials will take action against the state, the Times reports. Comments

“The federal government and the state are working in good faith to implement this process,” Rosenstein said, adding, “It would be impossible to implement this on July 1 from a practical standpoint. We don’t want people looking back at this effort and saying the state of California really messed this up.” Rosenstein said he would like HHS to expand the types of documents allowed to verify eligibility to include military discharge records and sworn affidavits, among other forms. Peter Warren, spokesperson for the California Medical Association, said, “We applaud them for steps they are taking to make this more workable.” Jim Lott, executive vice president of the Hospital Association of Southern California, said he was concerned that hospitals and emergency rooms could see more uninsured patients if the rule is not carefully implemented. Lott said, “If they have no coverage, they will find their care in the emergency room, where they can’t be turned away.” John Stone, a spokesperson for Rep. Charlie Norwood (R-Ga.) — who supported the measure — said, “We want to see the law enforced. Every bit of loss of funds means a loss of benefits to low-income Americans who were entitled to receive them” (Los Angeles Times, 6/7).

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