Irving City Council Endorses Criminal Alien Program
The Irving City Council has approved the Criminal Alien Program (CAP) as the Irving Police Department’s official policy for addressing prisoners who are not U.S. citizens.
The Police Department initiated an arrangement with the Immigration and Customs Enforcement (ICE) in September in which an ICE agent made weekly visits to the Irving Jail to determine the residency status of prisoners.
A new process with the Detention and Removal Division of ICE was implemented in April where residency status is reviewed over the phone 24 hours a day, seven days a week. This change has increased the number of illegal aliens identified from an average of 52 to 130 per month.
Every prisoner booked into the Irving Jail is rigorously screened regardless of charges. Those determined to be illegal aliens are released to ICE or transferred to the Dallas County Jail with an ICE hold. Since partnering with ICE, more than 700 illegal aliens have been removed from the Irving Jail.
“Irving is a model community for other cities. As we utilize the Criminal Alien Program, we will continue making strides toward maintaining the safety of our residents,” said Mayor Herbert Gears. “We are extremely pleased with the success and cost-effectiveness that the program has provided our community, and look forward to continued success in the future.”
http://cityofirving.org/corporate-communications/key-focus/articles/public-safety/Council%20Endorses%20CAP.pdf
September 1, 2006
July 18, 2006
Texas Hospitals Reflect Debate on Immigration
July 18, 2006
By JULIA PRESTON
Correction Appended
DALLAS — The doctors and nurses at Parkland Memorial Hospital knew a lot about Zahira Domínguez, a maternity patient who was beginning to feel the squeeze of her contractions.
They knew that she had been born in Mexico, was a 15-year-old student at a Dallas high school and had gone to her prenatal checkups. They knew she was scared about giving birth.
What the hospital staff did not know, because they did not ask, was whether Ms. Domínguez was an illegal immigrant.
“I don’t want my doctors and nurses to be immigration agents,” said Dr. Ron J. Anderson, the president of Parkland.
Patients like Ms. Domínguez — uninsured Hispanic immigrants with uncertain immigration status — have flocked in recent years to public hospital emergency rooms and maternity wards in Texas, California and other border states. Their care has swelled costs for struggling hospitals and increased the health care bills that fall to states and counties, giving ammunition to opponents of illegal immigration who complain of undue burdens on local taxpayers.
As a result, health care has become one of the sorest issues in the border states’ debate over illegal immigration. Facing harsh criticism from residents, public hospitals are confronted with an uneasy decision: demand immigration documents from patients and deny subsidized care to those who lack them, or follow the public health principle of providing basic care to anyone who needs it.
In Texas, two of the biggest public hospitals chose differently.
The Parkland Health and Hospital System, which serves Dallas County, offers low-cost care to low-income residents with no questions asked about immigration status.
“We decided that these are folks living in our community and we needed to render the care,” Dr. Anderson said.
In Fort Worth, in neighboring Tarrant County, JPS Health Network requires foreign-born patients to show legal immigration documents to receive financial assistance in nonemergencies, like elective surgery and the treatment of routine or chronic illnesses. Executives said that their first responsibility was to legal residents, but that they were uncomfortable about having to make such distinctions.
“I don’t think you should ask the hospital to make moral decisions for the State of Texas or, for that matter, for the United States,” said Robert Earley, a senior vice president of JPS.
To some Fort Worth residents, the hospital — which does provide emergency and maternity care to illegal immigrants — has nonetheless sent a message that illegal immigrants are not welcome.
“Whenever immigrants go to the hospital, the first thing they are asked is, ‘Who are you and where are your immigration papers?’ ” said José Aguilar, a leader of Allied Communities of Tarrant, a coalition of church-based community groups that has pressured the JPS board to reverse its policy. “They are being scared away.”
Across Texas, the debate over illegal immigration has spilled into county commission hearings and hospital board meetings. A study ordered by commissioners in Harris County, which includes Houston, found that about one-fifth of the patients in its health system last year were immigrants without documents, most of them from Mexico. Their numbers had increased 44 percent in three years, the study found, and their care had cost the county $97.3 million, about 14 percent of the health system’s total operating costs.
“We have a lot of United States citizens that need our help in health, and we should pull them up before we pull up someone here illegally,” said Tim Gallagher, 45, a software salesman from Plano, north of Dallas, who in an interview expressed views widely shared in the state. Mr. Gallagher said he favored deporting illegal immigrants who sought care from public facilities, even if the patient was a mother who gave birth to an American citizen.
“If somebody here needs health care, they should get it, and then if they are illegal, they should go bye-bye,” said Mr. Gallagher, who wrote a letter on the subject to The Dallas Morning News.
In California, hospitals spent at least $1.02 billion last year on health care for illegal immigrants that was not reimbursed by federal or state programs, according to federal government estimates. Hospital officials there said the ailing health care system was being pushed to its limit.
“Emergency rooms and hospital doctors are forced to subsidize the lack of immigration enforcement by the federal government,” said C. Duane Dauner, president of the California Hospital Association. “It amounts to an unfunded mandate for us to treat everybody.”
California received $66 million in federal money in 2005, the first year of a four-year national program to help pay for emergency care for illegal immigrants. But it was “not even a down payment” on the total cost, Mr. Dauner said. With more than 1.4 million of California’s residents uninsured and more than half of California’s hospitals operating in the red, Mr. Dauner warned that care for illegal immigrants could tip some hospitals into bankruptcy.
Even so, the surging numbers of illegal immigrants in the health care system have fed some misconceptions, hospital administrators said.
While Texas border hospitals often get “anchor babies” — children of Mexican women who dart across the border to give birth to an American citizen — most illegal immigrants who go to major hospitals in Texas can show that they have been living here for years, said Ernie Schmid, policy director at the Texas Hospital Association. Many immigrant families have mixed status; often a patient with no documents has a spouse or children who are legal.
Most immigrant patients have jobs and pay taxes, through paycheck deductions or property taxes included in their rent, administrators at the Dallas and Fort Worth hospitals said. At both institutions, they have a better record of paying their bills than low-income Americans do, the administrators said.
The largest group of illegal immigrant patients is pregnant women, hospital figures show. Contrary to popular belief here, their care is not paid for through local taxes. Under a 2002 amendment to federal regulations, the births are covered by federal taxes through Medicaid because their children automatically become American citizens.
These cases are not affected by new regulations that went into effect on July 1 requiring Medicaid patients to provide proof of citizenship, Texas health officials said. They said they believed that only small numbers of illegal immigrants had received other Medicaid benefits.
Administrators at Parkland said the hospital delivered 11,500 babies last year to mothers who were probably illegal immigrants, representing at least 56 percent of its maternity patients.
One was Ms. Domínguez, whose family brought her to Dallas from Mexico 11 years ago. Guided through Parkland’s prenatal care, the frightened teenager had an unexceptional labor and a robust baby girl.
Many immigrants have sought low-cost care by going to Parkland’s emergency room, where, by federal law, they must be examined and treated, as is the case in any emergency room. Leticia Martínez, 24, walked into the emergency room one morning weak with cramps, fearing a miscarriage in her two-month pregnancy.
Ms. Martínez said she had been sure she would get care at Parkland because her first baby had been born there. “They help economically,” she said. “They don’t ask the immigration question.”
Dr. Anderson fiercely defends Parkland’s open policy. “It’s much wiser to render care than to wait until they are very sick,” he said.
In Fort Worth, JPS Health Network also provides low-cost prenatal care and delivery for illegal immigrant mothers. It does not offer them help for other nonemergency care.
In January 2004, the JPS board of managers voted to offer its financial assistance program to all Tarrant County residents, legal or otherwise. But eight months later, with illegal immigrants starting to fill the hospital, the managers reversed course in a meeting where they agonized over their votes, the minutes show.
The policy has given the hospital a mixed reputation among Hispanics in Fort Worth.
Edy Patricia Rodríguez, 18, an illegal immigrant whose husband is an American citizen, cuddled her newborn recently in a private, state-of-the-art room at the JPS hospital. The child, Pablo F. Ibarra, born June 28, thrived in the network’s care, and his mother was satisfied.
But misunderstandings about immigration status clouded the case of Victoria Canales, a Mexican immigrant who had sought care for advanced liver disease, said her husband, Jesus Canales, 36.
Mrs. Canales was a legal resident and a member of the JPS network’s low-income program. But hospital staff members seemed confused about her case, Mr. Canales said, and twice sent her home when she had gone to seek relief from the liquid filling her body.
Humiliated, Mrs. Canales was reluctant to return to the hospital until she could no longer manage at home, Mr. Canales said. She died June 26.
JPS officials say they do not refuse care to people who need it, but are wrestling with the demands of county residents and changing state laws.
Mr. Earley, the JPS vice president, said, “We have been bounced around like a basketball on this issue.”
Correction: July 20, 2006
A front-page article on Tuesday about hospital care for illegal immigrants in Texas and other border states misstated the number of California residents who have no health insurance. It is more than 6.4 million people, not more than 1.4 million.
By JULIA PRESTON
Correction Appended
DALLAS — The doctors and nurses at Parkland Memorial Hospital knew a lot about Zahira Domínguez, a maternity patient who was beginning to feel the squeeze of her contractions.
They knew that she had been born in Mexico, was a 15-year-old student at a Dallas high school and had gone to her prenatal checkups. They knew she was scared about giving birth.
What the hospital staff did not know, because they did not ask, was whether Ms. Domínguez was an illegal immigrant.
“I don’t want my doctors and nurses to be immigration agents,” said Dr. Ron J. Anderson, the president of Parkland.
Patients like Ms. Domínguez — uninsured Hispanic immigrants with uncertain immigration status — have flocked in recent years to public hospital emergency rooms and maternity wards in Texas, California and other border states. Their care has swelled costs for struggling hospitals and increased the health care bills that fall to states and counties, giving ammunition to opponents of illegal immigration who complain of undue burdens on local taxpayers.
As a result, health care has become one of the sorest issues in the border states’ debate over illegal immigration. Facing harsh criticism from residents, public hospitals are confronted with an uneasy decision: demand immigration documents from patients and deny subsidized care to those who lack them, or follow the public health principle of providing basic care to anyone who needs it.
In Texas, two of the biggest public hospitals chose differently.
The Parkland Health and Hospital System, which serves Dallas County, offers low-cost care to low-income residents with no questions asked about immigration status.
“We decided that these are folks living in our community and we needed to render the care,” Dr. Anderson said.
In Fort Worth, in neighboring Tarrant County, JPS Health Network requires foreign-born patients to show legal immigration documents to receive financial assistance in nonemergencies, like elective surgery and the treatment of routine or chronic illnesses. Executives said that their first responsibility was to legal residents, but that they were uncomfortable about having to make such distinctions.
“I don’t think you should ask the hospital to make moral decisions for the State of Texas or, for that matter, for the United States,” said Robert Earley, a senior vice president of JPS.
To some Fort Worth residents, the hospital — which does provide emergency and maternity care to illegal immigrants — has nonetheless sent a message that illegal immigrants are not welcome.
“Whenever immigrants go to the hospital, the first thing they are asked is, ‘Who are you and where are your immigration papers?’ ” said José Aguilar, a leader of Allied Communities of Tarrant, a coalition of church-based community groups that has pressured the JPS board to reverse its policy. “They are being scared away.”
Across Texas, the debate over illegal immigration has spilled into county commission hearings and hospital board meetings. A study ordered by commissioners in Harris County, which includes Houston, found that about one-fifth of the patients in its health system last year were immigrants without documents, most of them from Mexico. Their numbers had increased 44 percent in three years, the study found, and their care had cost the county $97.3 million, about 14 percent of the health system’s total operating costs.
“We have a lot of United States citizens that need our help in health, and we should pull them up before we pull up someone here illegally,” said Tim Gallagher, 45, a software salesman from Plano, north of Dallas, who in an interview expressed views widely shared in the state. Mr. Gallagher said he favored deporting illegal immigrants who sought care from public facilities, even if the patient was a mother who gave birth to an American citizen.
“If somebody here needs health care, they should get it, and then if they are illegal, they should go bye-bye,” said Mr. Gallagher, who wrote a letter on the subject to The Dallas Morning News.
In California, hospitals spent at least $1.02 billion last year on health care for illegal immigrants that was not reimbursed by federal or state programs, according to federal government estimates. Hospital officials there said the ailing health care system was being pushed to its limit.
“Emergency rooms and hospital doctors are forced to subsidize the lack of immigration enforcement by the federal government,” said C. Duane Dauner, president of the California Hospital Association. “It amounts to an unfunded mandate for us to treat everybody.”
California received $66 million in federal money in 2005, the first year of a four-year national program to help pay for emergency care for illegal immigrants. But it was “not even a down payment” on the total cost, Mr. Dauner said. With more than 1.4 million of California’s residents uninsured and more than half of California’s hospitals operating in the red, Mr. Dauner warned that care for illegal immigrants could tip some hospitals into bankruptcy.
Even so, the surging numbers of illegal immigrants in the health care system have fed some misconceptions, hospital administrators said.
While Texas border hospitals often get “anchor babies” — children of Mexican women who dart across the border to give birth to an American citizen — most illegal immigrants who go to major hospitals in Texas can show that they have been living here for years, said Ernie Schmid, policy director at the Texas Hospital Association. Many immigrant families have mixed status; often a patient with no documents has a spouse or children who are legal.
Most immigrant patients have jobs and pay taxes, through paycheck deductions or property taxes included in their rent, administrators at the Dallas and Fort Worth hospitals said. At both institutions, they have a better record of paying their bills than low-income Americans do, the administrators said.
The largest group of illegal immigrant patients is pregnant women, hospital figures show. Contrary to popular belief here, their care is not paid for through local taxes. Under a 2002 amendment to federal regulations, the births are covered by federal taxes through Medicaid because their children automatically become American citizens.
These cases are not affected by new regulations that went into effect on July 1 requiring Medicaid patients to provide proof of citizenship, Texas health officials said. They said they believed that only small numbers of illegal immigrants had received other Medicaid benefits.
Administrators at Parkland said the hospital delivered 11,500 babies last year to mothers who were probably illegal immigrants, representing at least 56 percent of its maternity patients.
One was Ms. Domínguez, whose family brought her to Dallas from Mexico 11 years ago. Guided through Parkland’s prenatal care, the frightened teenager had an unexceptional labor and a robust baby girl.
Many immigrants have sought low-cost care by going to Parkland’s emergency room, where, by federal law, they must be examined and treated, as is the case in any emergency room. Leticia Martínez, 24, walked into the emergency room one morning weak with cramps, fearing a miscarriage in her two-month pregnancy.
Ms. Martínez said she had been sure she would get care at Parkland because her first baby had been born there. “They help economically,” she said. “They don’t ask the immigration question.”
Dr. Anderson fiercely defends Parkland’s open policy. “It’s much wiser to render care than to wait until they are very sick,” he said.
In Fort Worth, JPS Health Network also provides low-cost prenatal care and delivery for illegal immigrant mothers. It does not offer them help for other nonemergency care.
In January 2004, the JPS board of managers voted to offer its financial assistance program to all Tarrant County residents, legal or otherwise. But eight months later, with illegal immigrants starting to fill the hospital, the managers reversed course in a meeting where they agonized over their votes, the minutes show.
The policy has given the hospital a mixed reputation among Hispanics in Fort Worth.
Edy Patricia Rodríguez, 18, an illegal immigrant whose husband is an American citizen, cuddled her newborn recently in a private, state-of-the-art room at the JPS hospital. The child, Pablo F. Ibarra, born June 28, thrived in the network’s care, and his mother was satisfied.
But misunderstandings about immigration status clouded the case of Victoria Canales, a Mexican immigrant who had sought care for advanced liver disease, said her husband, Jesus Canales, 36.
Mrs. Canales was a legal resident and a member of the JPS network’s low-income program. But hospital staff members seemed confused about her case, Mr. Canales said, and twice sent her home when she had gone to seek relief from the liquid filling her body.
Humiliated, Mrs. Canales was reluctant to return to the hospital until she could no longer manage at home, Mr. Canales said. She died June 26.
JPS officials say they do not refuse care to people who need it, but are wrestling with the demands of county residents and changing state laws.
Mr. Earley, the JPS vice president, said, “We have been bounced around like a basketball on this issue.”
Correction: July 20, 2006
A front-page article on Tuesday about hospital care for illegal immigrants in Texas and other border states misstated the number of California residents who have no health insurance. It is more than 6.4 million people, not more than 1.4 million.
June 30, 2006
Medicaid Rule Called A Threat To Millions
Medicaid Rule Called A Threat To Millions
Proof of Citizenship Needed for Benefits
By Susan Levine and Mary Otto
Washington Post Staff Writers
Friday, June 30, 2006; Page A01
A Medicaid rule takes effect tomorrow that will require more than 50 million poor Americans to prove their citizenship or lose their medical benefits or long-term care.
Under the rule, intended to curb fraud by illegal immigrants, such proof as a passport or a birth certificate must be offered at the time a person applies for Medicaid benefits or during annual reenrollment in the state-federal program for the poor and disabled.
Critics fear that the provision will have the unintended consequence of harming several million U.S. citizens who, for a variety of reasons, will not be able to produce the necessary paperwork. They include mentally ill, mentally retarded and homeless people, as well as elderly men and women, especially African Americans born in an era when hospitals in the rural South barred black women from their maternity wards.
"My clients are absolutely dependent on Medicaid for their care," said Andrea Sloan, a lawyer and court-appointed guardian for more than 40 District residents. Many suffer from dementia, lack family contacts and have little in the way of paper trails. Although Sloan is convinced of their citizenship, she is not always sure of such details as their birthplace.
The new provision is part of last year's Deficit Reduction Act, which President Bush signed into law in February. Despite a federal inspector general's report concluding that there was little fraud by noncitizens, supporters said the measure would ensure that Medicaid dollars go only to citizens or eligible immigrants.
Rep. Charles Whitlow Norwood Jr. (R-Ga.), one of the prime sponsors, decried "the outright theft of Medicaid benefits by illegal aliens."
A lawsuit filed in federal court in the District yesterday contests the new rule's constitutionality and seeks to prevent its implementation in the city, where more than 140,000 residents receive Medicaid. "The rule's going to exclude citizens and deny them rights that citizens are entitled to," said Clifton Elgartenm, a lawyer with Crowell & Moring, which is working pro bono and sued the District on behalf of the nonprofit social services organization Bread for the City and individual plaintiffs.
One plaintiff is Alphonso DeShields, who was born in his parents' home in Spartanburg, S.C., a few months after World War I began. For five years, he has lived in a nursing home in Northwest Washington. He has a severe heart condition, cancer and other ailments.
"With respect to each of the documents" Medicaid would have him supply, the lawsuit states, "Alphonso DeShields possesses neither an original of such a document nor a copy of such a document certified by the original issuing agency."
District officials, like their counterparts in the states, have no choice but to comply; otherwise, federal Medicaid funds would be withheld. About $900 million would be at stake in the District alone.
Robert Maruca, head of the D.C. Medical Assistance Administration, said yesterday that he expects that many residents with a right to Medicaid will be unable to demonstrate their citizenship.
"I'm afraid they may be dropped out of the program," he said.
On Wednesday, a lawsuit challenging the Medicaid rule was filed in Chicago by a coalition of advocacy groups that wants the suit certified as a national class action. "In the process of pandering on the illegal immigrant issue, members of Congress will do enormous harm to the American citizens who need help the most," Ron Pollack, executive director of Families USA, said during a teleconference.
Among the plaintiffs in that case are Ruby Bell, 95, born in an Arkansas county that did not issue birth certificates until 1914, and George Crawford, 80, who is so incapacitated from strokes that he cannot speak. According to attorneys, the church members who care for Crawford in Illinois don't even know where to start looking for documents that would pass muster.
Until now, Medicaid recipients have declared their citizenship, under penalty of perjury, without having to show evidence of it. States have been able to demand substantiation in suspicious cases. No longer will that process suffice.
New applicants will be affected immediately and will be denied benefits until they offer proof of citizenship. Current recipients will not have to back up their declarations until their first annual reenrollment, when they will have 45 to 90 days to do so, depending on their circumstances.
Medicaid spokeswoman Mary Kahn said the federal Centers for Medicare and Medicaid Services had made "every concerted effort to ensure [the requirement is] not overly burdensome on beneficiaries." She declined to comment on the litigation.
In a June 9 memo to states, federal officials announced a hierarchy of documents that would be acceptable. Virtually all must be accompanied by a driver's license or something else establishing a person's identity -- another obstacle for young and old alike, critics stress. Medical, insurance or census records can be used under specific conditions. Entries in family Bibles don't qualify.
The provision "throws out a dragnet and says, 'All of you, all 50 million of you, need to come in here and document your citizenship whether we think there's a problem or not,' " said John Bouman, a lawyer with the Sargent Shriver National Center on Poverty Law.
On Capitol Hill yesterday, several members of Congress called for a delay in implementation. They said verification will effectively bar some Medicaid recipients from health care. Just how many is unclear. The Congressional Budget Office estimated that the requirement would cause 35,000 people, mostly illegal immigrants, to lose coverage by 2015 and lower Medicaid spending by $735 million over 10 years.
But the Kaiser Commission on Medicaid and the Uninsured has warned that the benefits of many citizens will be delayed or denied. Cindy Mann, director of the Center for Children and Family at Georgetown University's Health Policy Institute, suggested that at least 3 million citizens could be stripped of coverage.
"We are risking people's health care," she said. "And it is a lot of paperwork to solve a problem no one identified."
For the states, administrative costs will be considerable. Maryland and Virginia each have more than 700,000 Medicaid enrollees.
"We've been working pretty feverishly to try and figure out what this means," said Charles Lehman, director of medical care programs for the Maryland Department of Health and Mental Hygiene.
Stephanie Sivert, manager of Virginia's medical assistance program, said clients who are mentally disabled or homeless, living in institutional settings, often have made a complete break with their pasts.
"It's not going to be easy for them to access these records," she said.
Proof of Citizenship Needed for Benefits
By Susan Levine and Mary Otto
Washington Post Staff Writers
Friday, June 30, 2006; Page A01
A Medicaid rule takes effect tomorrow that will require more than 50 million poor Americans to prove their citizenship or lose their medical benefits or long-term care.
Under the rule, intended to curb fraud by illegal immigrants, such proof as a passport or a birth certificate must be offered at the time a person applies for Medicaid benefits or during annual reenrollment in the state-federal program for the poor and disabled.
Critics fear that the provision will have the unintended consequence of harming several million U.S. citizens who, for a variety of reasons, will not be able to produce the necessary paperwork. They include mentally ill, mentally retarded and homeless people, as well as elderly men and women, especially African Americans born in an era when hospitals in the rural South barred black women from their maternity wards.
"My clients are absolutely dependent on Medicaid for their care," said Andrea Sloan, a lawyer and court-appointed guardian for more than 40 District residents. Many suffer from dementia, lack family contacts and have little in the way of paper trails. Although Sloan is convinced of their citizenship, she is not always sure of such details as their birthplace.
The new provision is part of last year's Deficit Reduction Act, which President Bush signed into law in February. Despite a federal inspector general's report concluding that there was little fraud by noncitizens, supporters said the measure would ensure that Medicaid dollars go only to citizens or eligible immigrants.
Rep. Charles Whitlow Norwood Jr. (R-Ga.), one of the prime sponsors, decried "the outright theft of Medicaid benefits by illegal aliens."
A lawsuit filed in federal court in the District yesterday contests the new rule's constitutionality and seeks to prevent its implementation in the city, where more than 140,000 residents receive Medicaid. "The rule's going to exclude citizens and deny them rights that citizens are entitled to," said Clifton Elgartenm, a lawyer with Crowell & Moring, which is working pro bono and sued the District on behalf of the nonprofit social services organization Bread for the City and individual plaintiffs.
One plaintiff is Alphonso DeShields, who was born in his parents' home in Spartanburg, S.C., a few months after World War I began. For five years, he has lived in a nursing home in Northwest Washington. He has a severe heart condition, cancer and other ailments.
"With respect to each of the documents" Medicaid would have him supply, the lawsuit states, "Alphonso DeShields possesses neither an original of such a document nor a copy of such a document certified by the original issuing agency."
District officials, like their counterparts in the states, have no choice but to comply; otherwise, federal Medicaid funds would be withheld. About $900 million would be at stake in the District alone.
Robert Maruca, head of the D.C. Medical Assistance Administration, said yesterday that he expects that many residents with a right to Medicaid will be unable to demonstrate their citizenship.
"I'm afraid they may be dropped out of the program," he said.
On Wednesday, a lawsuit challenging the Medicaid rule was filed in Chicago by a coalition of advocacy groups that wants the suit certified as a national class action. "In the process of pandering on the illegal immigrant issue, members of Congress will do enormous harm to the American citizens who need help the most," Ron Pollack, executive director of Families USA, said during a teleconference.
Among the plaintiffs in that case are Ruby Bell, 95, born in an Arkansas county that did not issue birth certificates until 1914, and George Crawford, 80, who is so incapacitated from strokes that he cannot speak. According to attorneys, the church members who care for Crawford in Illinois don't even know where to start looking for documents that would pass muster.
Until now, Medicaid recipients have declared their citizenship, under penalty of perjury, without having to show evidence of it. States have been able to demand substantiation in suspicious cases. No longer will that process suffice.
New applicants will be affected immediately and will be denied benefits until they offer proof of citizenship. Current recipients will not have to back up their declarations until their first annual reenrollment, when they will have 45 to 90 days to do so, depending on their circumstances.
Medicaid spokeswoman Mary Kahn said the federal Centers for Medicare and Medicaid Services had made "every concerted effort to ensure [the requirement is] not overly burdensome on beneficiaries." She declined to comment on the litigation.
In a June 9 memo to states, federal officials announced a hierarchy of documents that would be acceptable. Virtually all must be accompanied by a driver's license or something else establishing a person's identity -- another obstacle for young and old alike, critics stress. Medical, insurance or census records can be used under specific conditions. Entries in family Bibles don't qualify.
The provision "throws out a dragnet and says, 'All of you, all 50 million of you, need to come in here and document your citizenship whether we think there's a problem or not,' " said John Bouman, a lawyer with the Sargent Shriver National Center on Poverty Law.
On Capitol Hill yesterday, several members of Congress called for a delay in implementation. They said verification will effectively bar some Medicaid recipients from health care. Just how many is unclear. The Congressional Budget Office estimated that the requirement would cause 35,000 people, mostly illegal immigrants, to lose coverage by 2015 and lower Medicaid spending by $735 million over 10 years.
But the Kaiser Commission on Medicaid and the Uninsured has warned that the benefits of many citizens will be delayed or denied. Cindy Mann, director of the Center for Children and Family at Georgetown University's Health Policy Institute, suggested that at least 3 million citizens could be stripped of coverage.
"We are risking people's health care," she said. "And it is a lot of paperwork to solve a problem no one identified."
For the states, administrative costs will be considerable. Maryland and Virginia each have more than 700,000 Medicaid enrollees.
"We've been working pretty feverishly to try and figure out what this means," said Charles Lehman, director of medical care programs for the Maryland Department of Health and Mental Hygiene.
Stephanie Sivert, manager of Virginia's medical assistance program, said clients who are mentally disabled or homeless, living in institutional settings, often have made a complete break with their pasts.
"It's not going to be easy for them to access these records," she said.
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