New rules cause confusion

By Timothy Pratt (contact)

Friday, Nov. 24, 2006 | 7:03 a.m.

Melba Borrero got a phone call Tuesday morning from a young mother who had been enthusiastic about applying for Medicaid for her 4-year-old daughter weeks before.

The woman told Borrero - an eligibility specialist at the Martin Luther King Family Center, a West Las Vegas low-income clinic - that she had decided not to finish the application, afraid that immigration authorities would use the required documents to deport her, although the application was for her U.S.-born daughter.

The woman, who did not want to be identified, is among a growing number of people in Nevada who either do not finish applying for Medicaid or are eventually rejected because of new federal rules requiring applicants and people renewing their coverage to prove they are citizens.

The rules, which affect up to 160,000 people on Medicaid statewide, have "put another hurdle in front of people ... (and) make potentially eligible people less likely to access services," said Steven C. Hansen, chief executive of Nevada Health Centers Inc., a nonprofit organization that runs 14 Nevada clinics for low-income patients.

Although Borrero's client was applying on behalf of a U.S. citizen, her own immigration status made her fearful of completing the application.

Other people who may have trouble meeting the new requirement include the homeless, disabled people and survivors of natural disasters, experts said.

Several months of data since the rules went into effect in July suggest that hundreds in Nevada may be missing out on the program because of the change.

Under the new requirement, applicants must provide a passport or a birth certificate and other identification. The documents must be original or certified copies.

Local and national observers argue that the legislation behind the rules was a misguided attempt to solve a problem they say doesn't exist: undocumented immigrants applying for Medicaid.

"Our mind is that people applying for Medicaid are not undocumented," Hansen said.

The requirement's main effect "is likely to be to impede or delay coverage for significant numbers of eligible U.S. citizens," said Donna Cohen Ross, director of outreach at the Center on Budget and Policy Priorities, a Washington nonpartisan group that opposes the change.

Nevada public and private officials said there already may be signs of that effect.

Bob Reardon, a management analyst at the state Welfare Division, said denial rates for Medicaid applicants rose from an average of 2,000 monthly to 2,758 in August and September.

Although Reardon said the state is not keeping track of denials based on the citizenship requirement, he added: "I would think people are having trouble with this."

Hansen said he has seen the average monthly number of applicants at his clinics drop from about 70 to 53 during the last three months.

Before the new rules, states had the option of requiring proof of citizenship to Medicaid applicants, Cohen Ross said. Nevada was among the 46 states that did not require proof.

Borrero said reasons for not being able to meet the new requirement include not having the money to obtain documents or not trusting a government agency with original documents.

In other instances, undocumented immigrant mothers applying on behalf of U.S. citizen children are being scared away by the rules.

"They're afraid to leave documents with a government agency because they think immigration authorities will see those documents and come after them," she said.

Cohen Ross said the new rules likely are affecting "not just the undocumented, but immigrants in general, since the message about who this targets is garbled."

U.S. residents - the step below citizenship - in the country legally for five years or more are eligible for Medicaid, but also may be shunning the program, she said.

"People are confused by the message (about the new rules)," she said, adding that the change is "a turnaround from the last 10 years, where they were trying to simplify the program."

Some congressmen share her concern. Rep. Henry Waxman, D-Calif., and Rep. John Dingell, D-Mich., wrote a Sept. 13 letter to the Government Accountability Office asking for an investigation into how the new rules are affecting access to health care and affecting costs for applicants and staff.

A Waxman staffer said the GAO is still considering the request.

Meanwhile, at her office Tuesday, Borrero said the Medicaid changes may soon add up to one thing: "A large number of sick children without health insurance."