More than 1 million Arizonans must prove they are U.S. citizens or risk losing their health insurance under a new Medicaid requirement that takes effect July 1.
State health administrators, nursing homes and hospitals are worried that hundreds or perhaps thousands of eligible residents will lose coverage under the Arizona Health Care Cost Containment System, the state’s version of Medicaid, or be unable to enroll in the program because they lack the required documentation.
The new federal law, part of the Deficit Reduction Act signed by President Bush on Feb. 8, is intended to ensure that illegal immigrants don’t receive Medicaid benefits by requiring a passport, birth certificate or other proof of citizenship for enrollment.
But state and federal officials agree that it’s likely to snag others — including children and nursing home residents — who cannot produce such documents.
“More than 50 percent (of AHCCCS members) are children, and the kids aren’t running around with passports,” AHCCCS deputy director Tom Betlach. “For older individuals, and especially Native Americans, it’s going to be a huge challenge.”
The Congressional Budget Office estimates the new law will save $220 million in the first five years and that roughly 35,000 people will lose coverage by 2015. Other sources, however, such as the liberal Center on Budget and Policy Priorities, put the number much higher, estimating that 3 percent to 5 percent of the 50 million low-income people on Medicaid could be at risk.
Hospital and nursing home officials fear the law will increase their costs as they care for people who can’t afford to pay the bills and would otherwise qualify for AHCCCS. In addition to American Indians, they’re concerned about the homeless, older Americans who were born at home and never had a birth certificate, those whose records have been lost or destroyed, and people with dementia.
“People who are cognitively impaired would have difficulty even addressing that issue,” said Kathleen Collins Pagels, executive director of the Arizona Health Care Association, which represents nursing homes.
“There’s just that core population that we know won’t fit in the box,” she said. “They won’t have those papers and they won’t have any way to get them. This will create a huge crisis.”
Pagels said some Arizona nursing home administrators estimate that 60 percent to 70 percent of their residents would be unable to produce citizenship documents. If their benefits are denied under AHCCCS, and there is no one else to care for them, Pagels said, nursing homes could wind up housing them for free.
Some of those costs can be recouped, she said, but already nursing homes lose an average $20 a day for every Medicaid patient because federal reimbursement does not cover the cost of their care.
Hospitals also are concerned that the new law will increase the percentage of patients who come to emergency rooms without insurance, said John Rivers of the Arizona Hospital and Healthcare Association.
“Our biggest worry is that this would delay or reduce enrollment for eligible individuals,” Rivers said. “We also have real doubts about how much money is going to be saved.”
Under Medicaid rules, AHCCCS already requires proof of identity and citizenship before a low-income Arizonan can receive benefits. That could include a written statement by relatives. Participants must re-enroll every six months or one year, primarily to determine income eligibility.
A 2005 study by the U.S. Department of Health and Human Services’ office of the inspector general concluded that there was no substantial evidence that illegal immigrants were claiming citizenship in order to get Medicaid benefits.
States are awaiting guidance from federal Medicaid authorities on how to implement the new law and hoping for flexibility on the types of acceptable documentation.
Anne M. Winter, health policy adviser to Gov. Janet Napolitano, said allowing alternative documents for children and the elderly, as well as “certificates of Indian blood” for American Indians, could ease the transition.
Winter said changing one word in the new law — from “alien” to “individual” — would align it with current statutes and exempt the 97,000 low-income elderly and disabled, who already qualify for both AHCCCS and Medicare.
States also are working on notifying AHCCCS members. Nearly 20 percent of Arizonans are covered by the lowincome health care program.
Arizona’s congressional delegation voted for the Deficit Reduction Act along party lines, with Democratic U.S. Reps. Ed Pastor of Phoenix and Raul Grijalva of Tucson opposing it.
Rep. Rick Renzi, R-Ariz., whose district includes the Navajo Reservation, has asked the Bush administration to allow certificates of Indian blood or other tribal identification as proof of citizenship.
“We will not let any Native American be denied access to healthcare on a bureaucratic technicality,” Renzi said in a statement to the Tribune. “If the Department of Health and Human Services can’t ensure this administratively, I am prepared to do it with legislation.”
East Valley Republican Reps. Jeff Flake, John Shadegg and J.D. Hayworth could not be reached for comment.
Arizona health care officials said Arizona’s poor, elderly and disabled should not be caught in the fervor over immigration reform. And some question whether lawmakers knew what they were voting for.
“We had no idea this was coming,” Rivers said. “I can only assume it was part of the fine print in the Deficit Reduction Act that someone put in there in the dead of night without informing anybody.”