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Health Advocates Fear Document Rules Make Medicaid Harder for Poor

Medicaid called harder for poor Health advocates fear document rules cause many to lose coverage By Kelly Brewington Sun reporter January 22, 2007 Public health advocates fear that a new federal regulation requiring Medicaid applicants to supply proof of identity and citizenship has resulted in thousands of poor Marylanders losing their health insurance. The requirement, part of the federal Deficit Reduction Act that went into effect in Maryland in September, was designed to prevent illegal immigrants from fraudulently receiving Medicaid, the nation's premier health insurance program for the poor. But advocates and health officers in some Maryland counties insist the rule has burdened citizens who need health care the most and is likely responsible for thousands of Marylanders being kicked off the Medicaid rolls. "It's a completely unnecessary law and Congress made a big mistake in passing it," said Laurie Norris, an attorney with the Public Justice Center. "The people who are on Medicaid in Maryland are supposed to be on Medicaid." The announcement of the regulations last June sparked an uproar among advocates and state health officials, who were given a July 1 deadline to enforce the mandate or risk losing federal funding. The officials complained they were not given enough time to train staff and inform Maryland's approximately 650,000 affected Medicaid recipients that they must furnish such identification as birth certificates, driver's licenses and passports. Nationwide, advocates feared huge enrollment declines, saying many of Medicaid's neediest recipients don't possess the necessary documents and would have to struggle to come up with the money to obtain them. Maryland, for instance, does not automatically issue birth certificates, which may be ordered for $12. Last summer, the federal government exempted from the requirement elderly and disabled Medicaid recipients who receive Supplemental Security Income from Social Security, and last month it extended the exemption to foster children. Still, states such as Virginia, Iowa, Wisconsin and New Hampshire noted plunging Medicaid enrollment figures and backlogs related to the regulation, according to a report released earlier this month by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. In Virginia, 12,000 children have been dropped from Medicaid rolls in the requirement's first four months of implementation, the report stated. In Maryland, Medicaid enrollment numbers are down overall, but state health officials say they are unsure whether the drop is due to the new rule, a point that has frustrated county health officers eager for evidence of the regulation's impact that they could use to push for change. >From August through December 2006, the state Department of Health and Mental Hygiene recorded about 6,000 fewer Medicaid enrollees statewide compared with the same period in 2005. Maryland officials say the enrollment computer system is not configured to determine the exact cause of the decline. "It is imperative that the state disclose data to demonstrate the impact of this law," said Dr. Joshua Sharfstein, Baltimore health commissioner. "There are warning signs that a major erosion in health coverage could be happening as a result of this new law. This is really concerning. ..." Charles Lehman, who oversees eligibility issues in the state's Medicaid office, said the agency has concentrated its limited resources on "keeping people on Medicaid rather than tracking the people going off." "It may not sound like we are doing everything we can, but really, we are, with the resources we have," he said. "It's not just the clients, not just the caseworkers, everyone has been impacted by this." Officials said while applicants are typically allowed a 30-day grace period, caseworkers will not discontinue the insurance if applicants are "making a good-faith effort" to obtain the documents. "I think we have done a good job applying the law appropriately but not in a way that arbitrarily cuts people off," said Lehman. "We have made our best effort to keep people on." The department has spent $1 million for a toll-free number to help applicants, 866-676-5880. The state health department has also partnered with other state databases to verify the citizenship and identity of beneficiaries, without requiring recipients to hand over documents. In July, the agency searched birth certificate records for about 600,000 Medicaid enrollees at the cost of $12 per search, said Lehman. But the effort has not gone as smoothly as hoped, said Norris, with the Public Justice Center. For instance, the databases are not automatically synched - staff must print out the information and check it by hand. "The state has been severely hampered in information technology," she said. Norris alerted state lawmakers to the problem at a briefing in Annapolis last week. The problems come during a push by advocates and some lawmakers and business groups to expand Medicaid and help about 780,000 uninsured Marylanders. Officials with local agencies have increased outreach and said they have allowed people extra time to provide the documents they need. Nevertheless, in Anne Arundel County, for example, denial rates for the state's Medicaid program for pregnant women and children have jumped from an average of 18 percent from June through December 2005 to 42 percent for the same period in 2006. "It's really shocking," said Frances Phillips, the county's health officer. "This is so serious because the people we are talking about are either children with no insurance and no way to access health care, or pregnant women." Many applicants eventually produce the documents and get back on Medicaid, Phillips noted. But for vulnerable populations, any discontinuation in coverage can be harmful, she said. A health department program in which nurses make home visits to women with at-risk pregnancies has focused on educating women on the documentation. "We just feel that this is so critical," said Phillips. " ... We touch base with the women, find out what is going on with them and make sure they get insurance." In Baltimore, outreach workers with Baltimore HealthCare Access Inc., which assists some of the city's estimated 200,000 Medicaid enrollees, are making home visits and contacting state agencies on applicants' behalf. The agency received $5,000 from the Abell Foundation to help applicants cover the cost of documents. "We are plowing away that money pretty quickly," said Kathleen Westcoat, the organization's president. The funding helped Brenda Kent, 36, pay for her birth certificate last month. She lost her wallet two months before she was due to apply for Medicaid benefits for herself, her twin sons and a daughter. "I didn't know how I was supposed to get it," said Kent, who does not work. "If they didn't help me with the cost, it would have taken me longer to do it." kelly.brewington@baltsun.com Copyright © 2007, The Baltimore Sun

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