More than 3,000 Arizonans have lost public health insurance in the past year because they couldn’t prove U.S. citizenship, though it’s unknown how many, if any, were in this country illegally.

Now advocates worry that eligible families will be denied food stamps and cash assistance under a state law that takes effect Wednesday and applies the same requirement to those benefits.

Already, Arizona taxpayers have spent more in administrative costs than they’ve saved in reduced Medicaid expenses since the federal law was implemented in June 2006.

A recent federal audit showed that most states are in the same boat, and nearly half report enrollment declines due to denying coverage to eligible citizens.

The Arizona Health Care Cost Containment System, the state’s Medicaid program, continues to grow, but there are concerns that the documentation requirements are preventing eligible people, including the U.S.-born children of foreign-born parents, from getting health care coverage. The new state law will have the same result when it comes to food stamps and cash benefits to families with children.

“We think there are a lot of people who may not even be applying because they don’t think they can get the papers together,” said Kim Van Pelt, health policy director for the Children’s Action Alliance.

The state law, passed in the final hours of the legislative session, gives applicants 30 days to provide proof of citizenship, such as a birth certificate or passport, to qualify for food stamps or Temporary Aid to Needy Families.

Like the federal Medicaid requirement, it’s intended to ensure that illegal immigrants don’t receive benefits. But state and federal officials acknowledged last year that the Medicaid rule would likely snag others who could not produce the required documents.

In Arizona, 3,188 people insured under AHCCCS, the state’s Medicaid program, have so far been denied coverage because they lacked the necessary documents.

Another 623 new applicants have been turned down for the same reason.

“In terms of who they are, we don’t have information on that,” said Tom Betlach, deputy director for AHCCCS. “In most cases, it’s as if, at some point in time, they gave up. They didn’t come back to the office.”

The numbers are small in relation to the AHCCCS population, and compared to many other states, who report tens of thousands of people have lost coverage. Advocates generally praise AHCCCS for its efforts to keep people insured.

“The problem isn’t our state. It’s the law itself,” Van Pelt said. “It’s addressing a problem that didn’t exist in a heavy-handed way.” Taxpayers spent $10.4 million in state and federal funds to hire eligibility workers to help prove citizenship for the 1 million Arizonans on AHCCCS. Given the average cost of $260 per AHCCCS member per month, the savings under the federal requirements amounts to just under $10 million.

In the past, applicants for public benefits in Arizona and most other states were required to sign an affidavit swearing they were U.S. citizens. State workers routinely checked Social Security numbers against a national database and required additional documentation only in special circumstances.

The state law, part of an 11th-hour political compromise between the Republican-controlled Legislature and Gov. Janet Napolitano, a Democrat, came with no money.

“It was explained to us as part of the budget deal and Proposition 300 cleanup language,” said Sen. Debbie Mc-Cune-Davis, D-Phoenix. “So none of those things set off alarm bells.”

Proposition 300, passed by voters in November, blocked illegal immigrants from child care, state-funded programs and in-state tuition at community colleges and public universities.

About 85 state employees were hired last year to help people find the necessary paperwork, scouring medical records and databases.

Since about 90 percent of people who receive food stamps or cash assistance also qualify for AHCCCS, state officials don’t anticipate the need to hire more eligibility workers to implement the new state law, said Liz Barker, spokeswoman for the state Department of Economic Security, which administers the programs.

“Our commitment is to do everything that we can to help individuals locate the documents that they need to prove citizenship,” Barker said.

National studies, including a recent General Accounting Office report, have shown that states are spending millions in administrative costs and knocking eligible people off Medicaid rolls under the law, part of the Deficit Reduction Act, but not reaping the benefits that had been anticipated.

“States reported that the requirement resulted in barriers to access, such as delayed or lost Medicaid coverage for some eligible individuals,” the GAO report said.

Federal health officials estimated savings of $50 million in the first year for the federal government and $40 million for the states. But the GAO report said just five of 44 states reported reduced Medicaid expenditures, and those were “due in large part to individuals who appeared to be eligible citizens who experience delays in or lost coverage.”

At St. Joseph’s Hospital and Medical Center, patients visiting from other states have lingered in comas, unable to get Medicaid approval because they didn’t have the papers.

“Our own citizens are having difficulty finding documentation,” said Sister Margaret McBride, vice president of mission service for the hospital. “I think it’s a huge challenge for the community.”

St. Joseph’s and other hospitals are required by federal law to treat anyone who appears in their emergency department, and they give away millions of dollars a year in charity care.

There’s no such requirement for other welfare programs.

“If you need medical care, you’re going to get it,” said Eddie Sissons of the Arizona Foundation for Behavioral Health. But if you’re denied food stamps, she said, “the best you’re going to get is an emergency food box.”

Finding help

For help finding proof of U.S. citizenship, call AHCCCS at (602) 417-7000, the state Department of Economic Security at (602) 542-9935 or KidsCare at (602) 417-5437