Guidelines from the federal Centers for Medicare and Medicaid Services require beneficiaries to have a passport or a birth certificate to verify they're eligible.
Bill Brumfield, director for human services in the Hennepin County Public Health Department, said the kinds of verification necessary to get Medicaid will be hard for many people to get ahold of in a timely manner.
"Our biggest concern is for those who are elderly or people who are disabled or people who have mental issues that make it very difficult for them to do these kinds of processes," Brumfield said.
For more than 20 years, non-citizens have been ineligible for Medicaid and other programs. Applicants currently declare their citizenship under penalty of perjury. In Minnesota, officials verify the declaration through Social Security or immigration documents. Starting July 1 that will no longer be enough. New applicants after that date will have to prove citizenship before getting benefits. People renewing Medicaid benefits won't face immediate cut-off as long as they make a good-faith effort toward verifying citizenship.
Amy Shillings, Hennepin County Human Services Representative, works to match disabled, elderly or other needy clients with programs for food, housing and medical support. Her team of 11 workers maintains a case load of around 2,000 clients. She said the new citizenship rule will create added headaches for a population that already has difficulty meeting simple, day-to-day challenges.
"It's not only a lot of work for us, but it's also a lot of work for the clients," Shillings said. "Especially if they don't have all that stuff with them. It costs $15 to get a certified birth certificate. A lot of people don't have the funds to do this; it's just a lot of work all around."
The law requiring more vigorous citizenship verification comes during a surge in concern about illegal immigrants. President Bush signed the bill in February. The idea was championed by Rep. Charlie Norwood, R-Ga., who had gotten reports of illegal immigrants in his state receiving services they aren't entitled to. In Minnesota, however, there's no evidence illegal immigrants are a significant drain on the system.
In a residential neighborhood on St. Paul's East Side, the American Indian Family Center offers financial and other support to needy Ramsey County clients. Director LaVon Lee knows firsthand that many in the population she sees on a daily basis will have trouble producing the required proof of citizenship.
"My uncle was born at home," she said. "He lives on a reservation and I've tried to obtain information, not only on my uncle but my mother. They're not in any type of official birth record in the state."
They're not in any type of official birth record in the state.
Lee notes American Indians were not even considered U.S. Citizens until the mid-1920s. She worries they will be among the many poor and minority residents shut out of benefits they're otherwise qualify for.
Judith Solomon is a senior fellow at the Center on Budget and Policy Priorities, a Washington D.C. organization that works to influence policy to help poor people. She said cutting out the low number of ineligible recipients aren't enough to reach the $735 million savings over the next ten years the bill's proponents are banking on.
"What you're really talking about is denying eligible citizens or delaying their eligibility. I would just submit achieving savings in that way is not something that we all should be trying to accomplish.
After criticisms the law would severely restrict eligible citizens, the Bush administration eased the requirements to allow two people to vouch for someone without proper documents. Solomon says the requirements still pose additional hurdles for needy and disabled people.
The center conducted a survey that found between 8 percent and 10 percent of people with incomes under $25,000 a year had no ready access to birth records or passports. At the same time, an audit in Oregon found a little over three percent of Medicaid recipients in that state received funds they shouldn't have.
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