Medicaid denies infant care based on parents’ immigration status

This is insidiously sinister—a step towards something akin to apartheid, two-tier citizenship. Not that we don’t already have that, of course, but this is close to legally acknowleding it and legitimizing it. From the New York Times Nov. 3, via

Medicaid Wants Citizenship Proof for Infant Care
WASHINGTON — Under a new federal policy, children born in the United States to illegal immigrants with low incomes will no longer be automatically entitled to health insurance through Medicaid, Bush administration officials said Thursday.

Doctors and hospitals said the policy change would make it more difficult for such infants, who are United States citizens, to obtain health care needed in the first year of life.

Illegal immigrants are generally barred from Medicaid but can get coverage for treatment of emergency medical conditions, including labor and delivery.

In the past, once a woman received emergency care under Medicaid for the birth of a baby, the child was deemed eligible for coverage as well, and states had to cover the children for one year from the date of birth.

Under the new policy, an application must be filed for the child, and the parents must provide documents to prove the child’s citizenship. The documentation requirements took effect in July, but some states have been slow to enforce them, and many doctors are only now becoming aware of the effects on newborns.

Obtaining a birth certificate can take weeks in some states, doctors said. Moreover, they said, illegal immigrant parents may be reluctant to go to a state welfare office to file applications because they fear contact with government agencies that could report their presence to immigration authorities.

Administration officials said the change was necessary under their reading of a new law, the Deficit Reduction Act, signed by President Bush in February. The law did not mention newborns, but generally tightened documentation requirements because some lawmakers were concerned that immigrants were fraudulently claiming United States citizenship to get Medicaid.

Marilyn E. Wilson, a spokeswoman for the Tennessee Medicaid program, said: “The federal government told us we have no latitude. All states must change their policies and practices. We will not be able to cover any services for the newborn until a Medicaid application is filed. That could be days, weeks or months after the child is born.”

About four million babies are born in the United States each year, and Medicaid pays for more than one-third of all births. The number involving illegal immigrant parents is unknown but is likely to be in the tens of thousands, health experts said.

Doctors and hospitals denounced the policy change and denied that it was required by the new law. Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said the policy “punishes babies who, according to the Constitution, are citizens because they were born here.”

Dr. Martin C. Michaels, a pediatrician in Dalton, Ga., said that continuous coverage in the first year of life was important because “newborns need care right from the start.”

“Some Americans may want to grant amnesty to undocumented immigrants, and others may want to send them home,” Dr. Michaels said. “But the children who are born here had no say in that debate.”

Under a 1984 law, infants born to pregnant women on Medicaid are in most cases deemed eligible for Medicaid for one year.

In an interview on Thursday, Leslie V. Norwalk, acting administrator of the Centers for Medicare and Medicaid Services, said the new policy “reflects what the new law says in terms of eligibility.”

“When emergency Medicaid pays for a birth,” Ms. Norwalk said, “the child is not automatically deemed eligible. But the child could apply and could qualify for Medicaid because of the family’s poverty status. If anyone knows about a child being denied care, we want to know about it. Please step up and tell us.”

Under federal law, hospitals generally have to examine and treat patients who need emergency care, regardless of their ability to pay. So the new policy is most likely to affect access to other types of care, including preventive services and treatment for infections and chronic conditions, doctors said.

Representative Charlie Norwood, Republican of Georgia, was a principal architect of the new law.

“Charlie’s intent was that every person receiving Medicaid needs to provide documentation,” said John E. Stone, a spokesman for Mr. Norwood, who is a dentist and has been active on health care issues. “With newborns, there should be no problem. All you have to do is provide a birth certificate or hospital records verifying birth.”

But Dr. Berkelhamer disagreed. Even when the children are eligible for Medicaid, he said, illegal immigrants may be afraid to apply because of “the threat of deportation.”

The new policy “will cost the health care system more in the long run,” Dr. Berkelhamer added, because children of illegal immigrants may go without immunizations, preventive care and treatments needed in the first year of life.

Doctors, children’s hospitals and advocacy groups have been urging states to preserve the old policy on Medicaid eligibility for children born to illegal immigrants.

Sara Rosenbaum, a professor of health law at George Washington University, said: “The new policy reflects a tortured reading of the new law and is contrary to the language of the 1984 statute, which Congress did not change. The whole purpose of the earlier law, passed with bipartisan support, was to make sure that a baby would not have a single day’s break in coverage from the date of birth through the first year of life.”

California has objected to the new policy. S. Kimberly Belshé, secretary of the California Health and Human Services Agency, said: “By virtue of being born in the United States, a child is a U.S. citizen. What more proof does the federal government need?”

See our last post on the immigration crackdown and the struggle for the border.

  1. NYS: no change in state policy
    From the Children’s Defense Fund-New York, Nov. 9:

    Automatic Enrollment of Newborns in NY Medicaid Will Not Change

    Despite confusing press reports released last week, eligible newborns will continue to be automatically enrolled in Medicaid without having to provide additional citizenship and identity documentation, despite the immigrant eligibility of their parents.

    On November 3rd, The New York Times ran the article, “Medicaid Wants Proof for Infant Care,” detailing how new citizenship documentation requirements may affect automatic enrollment of newborns in states throughout the country. This set off a series of misinformed news and radio reports in community and ethnic media about new immigrant eligibility changes.

    According to the New York State Department of Health, enrollment of newborns in New York Medicaid will not change. New York will continue to enroll newborns through the automated hospital reporting/newborn enrollment process. All the information necessary to establish the newborn’s eligibility is transmitted to the Medicaid program through Electronic Birth Certificate System (Vital Records). This match with Vital Records will document the child’s citizenship.

    New Yorkers Will Hold Governor-Elect Spitzer to His Pledge To Cover All Children

    Over the past few months, Governor-elect Eliot Spitzer has made no secret of his goal to provide health coverage for every child in New York State. Now is the time for him to deliver on this pledge. Families across New York State need him to act quickly and decisively, employing his tremendous mandate to solve a health crisis.

    All children need comprehensive health coverage. In New York State there are 384,000 uninsured children, more than 70 percent of whom are currently eligible but not enrolled in public health coverage. Uninsured children in New York are more than four times as likely as those with public health insurance coverage to lack a regular source of health care or to have an unmet need for prescription medicine.

    Providing health insurance coverage to every New York child can have two components: (1) extend subsidized health insurance coverage to nearly every child in families with incomes too high to be currently eligible; and (2) simplify and streamline application and renewal procedures in current programs so that all eligible children and teens can participate in the health insurance they need.

  2. Policy reversed…
    A small glimmer of hope. From the New York Times, March 21:

    U.S. to Offer Care to Infants of Illegal Immigrants

    WASHINGTON — In a reversal, the Bush administration said Tuesday that babies born in the United States to illegal immigrants with low incomes could automatically qualify for one year of Medicaid coverage, just as babies born to United States citizens did.

    Federal officials dropped their insistence that illegal immigrants document the citizenship of the newborns. State officials, hospitals and pediatricians had said the requirement made no sense because, under the 14th Amendment to the Constitution, people born in this country are United States citizens.

    The change came just 15 days after the State of Washington challenged the policy in a lawsuit. Gov. Chris Gregoire of Washington welcomed the change.

    “The Constitution could not be more clear,” Ms. Gregoire said. “Babies born in the United States are citizens, regardless of who their parents are.”

    Ms. Gregoire said the original policy, adopted last July, would have delayed care for 8,000 “infant citizens” of her state. Washington State had argued that the federal policy denied “equal protection of the laws” to citizen children of illegal immigrants.

    Leslie V. Norwalk, acting administrator of the federal Centers for Medicare and Medicaid Services, said: “We have heard the concerns and are taking action to ensure that newborns in similar circumstances are treated the same under Medicaid eligibility rules. We intend to modify the documentation requirements to put all babies born in the United States whose deliveries are covered by Medicaid on an equal footing.”

    Illegal immigrants are generally barred from Medicaid, but can get coverage for treatment of emergency medical conditions, including labor and delivery.

    The policy change affects only infants. Adults and children over the age of 1 will still be subject to documentation requirements established by a 2006 law. To obtain or keep Medicaid, they must present birth certificates, passports or other documents proving citizenship and identity.

    Senator Charles E. Grassley, Republican of Iowa, who had introduced a bill to overturn the administration policy, said Tuesday that the reversal was “a positive step.”

    Senator Jeff Bingaman, Democrat of New Mexico, said: “I’m glad the administration has taken this small step to fix a problem that it created. But we have a long way to go before the larger issue of citizenship documentation is resolved.”