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Medicaid patients soon required to prove citizenship

State health officials and advocates for the poor are worried about some new federal regulations that take effect next month. Beginning in July, all 50-million Medicaid recipients nationwide will have to prove they are either U.S citizens or legal residents.

Supporters say the new policy will prevent illegal immigrants from receiving benefits. But critics fear the law could limit access to healthcare for legal residents. KPBS Health Reporter Kenny Goldberg has the story.

It's not easy to get on California's Medicaid program called Medi-Cal.
Just ask Grenelin Barrios.

The San Diegan says it was a snap to qualify for Medi-Cal five years ago when her son was born. But lately, Barrios says she's hit a brick wall. Barrios says she's filled out the application, submitted her pay stubs, and even had a social worker visit her home. But to no avail.

Grenelin Barrios: "I don't know what's happening. I really don't know. Before it was easy. And now, they're making it so hard. I already resubmitted my papers two times, so I don't know what's gonna happen."

In the meantime, Barrios is seven months pregnant.

Barrios: "It's hard. I go home, and then I know I haven't had no prenatal care for like two months. And I know that, like something could be wrong with my baby, no ultrasound, no nothing. So, it's really stressful, cause I don't know if my baby's okay."

Medi-Cal benefits may soon be even harder to get. That's because a new federal law requires all beneficiaries to prove they're U.S. citizens or legal residents. The new rules take effect next month.

Georgia Congressman Charlie Norwood co-wrote the law. John Stone is his deputy chief of staff.

John Stone: "We discovered that a lot of illegal immigrants who were not supposed to receive Medicaid, who were receiving it fraudulently, are tying up the dollars and kicking low-income Americans off the roles.

Currently, Medicaid applicants in most states can simply self-certify that they're legally entitled to the benefits.

Stone says the new guidelines will require people to use passports, birth certificates, or final adoption papers to prove their status. He says if all else fails, applicants can get written affidavits from two U.S. citizens to verify their citizenship.

Stone: "So that anyone who legally should be receiving the benefit, is a U.S. citizen, doesn't lose it because of some technicality. But what we absolutely do is we put the brakes on illegal immigrants fraudulently taking Medicaid funds."

The Congressional Budget Office estimates the new requirement could save the government nearly three-quarters of billion dollars over the next decade.

But some healthcare providers think the new policy stinks.

Zara Marselian: "I really believe that the motive is to discourage as many people as possible from applying for benefits."


Zara Marselian directs La Maestra Family Clinic in San Diego's City Heights neighborhood. Her clinic treats some 36,000 patients a year. Most of them are uninsured.

She says the new law doesn't hurt illegal immigrants, because they're not entitled to full Medi-Cal benefits, anyway. Rather, Marselian says the guidelines affect U.S. citizens, who will be required to come up with all sorts of documentation many just don't have.

Marselian: "We're talking about people who are poor, that need to live with additional families. They're moving from time to time. It's hard to keep track of their documents. Sometimes they lose em. What about the homeless people, what about people that have mental health issues? And then the children."

Under the law, all recipients, including children, will have to show photo ID to qualify for Medi-Cal. A birth certificate alone won't suffice.

Stan Rosenstein is the director of the Medi-Cal program. He's hoping the federal government will be flexible.

Stan Rosenstein: "We don't want to have to send three million children to get photo ID's over the next year. That would be an impossible task."

The non-profit California Budget Project estimates up to 650,000 Medi-Cal recipients may lack the required documentation.

Stan Rosenstein fears the new policy could spell disaster for many Californians.
Rosenstein: "We're working very hard to avoid that. We want to make sure that this is done so that citizens of the United States maintain their healthcare coverage."
Rosenstein and other health officials hope there won't be widespread disruption.

Either way, one thing's for sure. Over the next year, state workers will have to verify and record the citizenship of the more than six-million Medi-Cal recipients.

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