State taxpayers will fork over $5.2 million to help prove U.S. citizenship and maintain health insurance for more than 1 million Arizonans under a new federal law that takes effect next week.
The state funds are in the budget awaiting Gov. Janet Napolitano’s signature, and they’ll be matched by the federal government. The sum, $10.4 million, will pay for hiring 130 eligibility workers to fulfill a new Medicaid requirement.
Local health officials are girding for an administrative nightmare, and say the federal guidelines released this month don’t ease their concerns, except to clarify that people won’t be kicked off the rolls if they prove they are actively seeking their paperwork.
“The one key message here is on July 1st, no one is losing their benefits,” said Rainey Daye Holloway, spokeswoman for the Arizona Health Care Cost Containment System, the state’s version of Medicaid. “As long as someone is showing a good-faith effort in obtaining those documents, nothing is going to happen.”
The law, signed by President Bush in February, is intended to ensure illegal immigrants don’t receive Medicaid benefits. State and federal officials warn it’s likely to snag U.S. citizens — including children, emergency room patients and the mentally ill — who can’t produce the right documents.
The new guidelines say people will have “reasonable opportunity” to find proof of citizenship — records such as birth certificates, passports or naturalization papers. But they caution state officials against taking too long helping people track down documents. “As far as we’re concerned, there isn’t a time limit,” Holloway said. But, she added, “certainly, the last thing we want to do is turn anybody away.”
Hospitals, nursing homes and drug treatment centers agree with Holloway, but worry they’ll be stuck with the bills when patients can’t prove their citizenship.
“The documents that they are directing us to use will be really hard to get,” said Frank Scarpati, CEO of Community Bridges, a substance-abuse treatment center in Mesa. “We can’t delay crisis care while somebody brings in documentation.”
Only three documents will be accepted as both proof of citizenship and identity: A U.S. passport, a certificate of naturalization or a certificate of U.S. citizenship. All other documents — birth certificates, adoption papers and military records — must be accompanied by proof of identity. Only originals or certified copies will be accepted.
“We’re hoping for the best, but expecting the worst,” said John Rivers, CEO of the Arizona Hospital and Healthcare Association.
Rivers, Scarpati and others are lobbying state and federal lawmakers to automatically exempt the 97,000 poorest and frailest Arizonans who qualify for AHCCCS and Medicare.
Rep. Rick Renzi, R-Ariz., convinced Medicaid to accept a “certificate of Indian blood” as proof of identify and citizenship for American Indian clients. His sprawling northeastern Arizona district includes the Navajo Nation, and San Carlos Apache and White Mountain Apache reservations.
The Congressional Budget Office estimates the new law will save $220 million in the first five years and predicts that 35,000 people will lose coverage by 2015. But other sources argue more people will lose out. The liberal Center on Budget and Policy Priorities estimates that up to 2.5 million, or 5 percent, of the 50 million low-income people on Medicaid could be at risk.
Holloway said an internal audit of 1,800 AHCCCS files turned up no evidence that illegal immigrants were claiming U.S. citizenship to receive benefits. That confirms 2005 findings by the U.S. Department of Health and Human Services inspector general.
Besides potential costs to hospitals, treatment centers and nursing homes, advocates worry that U.S.-born children with foreign-born parents will fall off the rolls.
“The requirement of providing documentation will drive them out of the system because their parents will be afraid of associating with it,” said David Miller, who heads the Arizona Council of Human Service Providers.
AHCCCS officials are speaking to community and health care organizations about the requirements. Holloway said officials will notify people three months before their eligibility is due to renew.
For help finding proof of U.S. citizenship and identity, call AHCCCS at (602) 417-7000, the state Department of Economic Security at (602) 542-9935 or KidsCare at (602) 417-5437. Or check online at