Medicaid: Will that be passport or green card?

Byline: Diane Dietz The Register-Guard

LAW CHANGES Federal: Medicaid recipients must provide proof of U.S. citizenship or legal residence, or the state will withhold payment. State: Prescription now needed to buy drugs containing pseudoephedrine to cut methamphetamine production. State: Drivers no longer have to slow down to 20 mph in school zones at night. The reduced speed applies only from 7 a.m. to 5 p.m. on school days and when children are present.

Congress provided no exceptions to a new law - which takes effect today - requiring all Medicaid recipients to prove they're citizens or legal aliens using documents such as birth certificates and passports.

The law, which aims to shear illegal immigrants from anti-poverty programs, applies even to people with Alzheimer's disease, seniors who can't rise unassisted from their nursing home beds and foster care children.

All must produce official papers or risk losing federal medical help and, in some cases, housing.

That has alarmed many experts, who say it can be very difficult, for example, for an ailing elderly person to find their birth certificate or passport - if they even have one.

The federal government encourages states to help people find or order copies of their birth certificates, but the onus is on the recipient.

About a half-million Oregonians who are elderly, mentally ill, disabled, or young and poor receive federal Medicaid benefits through the Oregon Health Plan.

"The (new) law has the potential to be very damaging to a lot of people in Oregon's long-term care system," said Rob Johnson of the Oregon Health Care Association, a nursing home and assisted living trade group. "It's sad: They're 80- and 90-year-old people. They're not the people a provision like this is aimed at."

The new citizenship requirement - adopted along with tax breaks for the wealthy as part of the federal Deficit Reduction Act of 2005 - is going to create trouble over the next year at some medical offices, nursing homes and family planning clinics, their operators say.

Heath providers envision paperwork gridlock, hard cases with no answers, scared and undocumented parents denying their U.S.-born children important medicine - such as immunizations - and, finally, a strain on the health system as officials attempt to collect the newly required documents.

About 70,000 Oregonians won't be able to readily offer proof of citizenship, Oregon officials estimate. Some are homeless, transient, mentally ill, developmentally disabled, frail and alone. Others survived disasters such as fires or hurricanes, but their paperwork didn't.

"Birth certificates are hard," said Mark Kinkade, owner of the Gateway Gardens elderly care center in Springfield. "Some folks were born in, like, a small rural community in Nebraska and the community is gone, or there was no hospital, there was no doctor. The birth certificate may never even have been produced."

This is especially true for blacks born last century in the rural, segregated South. Their parents may have had no access to hospitals or courthouses, and their children's arrival may have gone unnoticed by the official record.

The Oregon Health Care Association urges nursing home administrators to begin collecting documents for their residents who receive or anticipate receiving Medicaid.

The new federal law asks newly applying Medicaid recipients to present their documents immediately. Existing enrollees must requalify every six months, and they will be asked to present documents then - although Oregon will carry them for 45 to 60 days while they try to find documentation.

The June 9 federal directive warns that the federal government will audit the states' document-checking efforts. The law requires states to withhold Medicaid payments from undocumented residents or risk losing Medicaid for all residents of the state.

For residents who never find the paperwork, what will happen when the grace period runs out?

"That's a good question," said Johnson, spokesman for Oregon nursing homes. "It's a federal issue, and it's going to have to be resolved at the federal level."

The new law is worrisome to operators of the RiverStone Clinic in Springfield, which opened in March 2004 in part to serve Spanish-speaking residents who otherwise had little access to health care, clinic manager Selene Jaramillo said.

The Oregon Health Plan always has required new enrollees to check a box and assert that they are citizens or legal residents. Now, they'll have to prove it with a birth certificate, passport or similarly authoritative and hard-to-forge paperwork. A driver's license won't suffice.

Those who can't prove it can pay out of pocket and still receive care at RiverStone, Jaramillo said.

About 11 million undocumented immigrants live in the United States, according to the Pew Hispanic Center, a nonprofit research center. About 5 million of them are children, and 3 million of those children are U.S. citizens by virtue of birth, although in their homes one or both parents are in the country illegally.

This is Jaramillo's worry: When employees checking eligibility begin demanding documentation, families will stop bringing their children to the clinic - even though the children would qualify. The parents fear being deported and separated from their children.

"What if people are afraid they'll get deported and won't bring their children to be immunized?" Jaramillo said. "I don't want to be a doomsayer, but those are certainly things you think about."

Oregon has as many as 175,000 illegal immigrants, according to the Pew center.

The citizenship requirement poses a big problem for Planned Parenthood of Lane County, spokeswoman Kellie Shoemaker said. Statewide, the agency sees 156,000 patients, including 101,000 who are covered by federal dollars that carry the citizenship requirement.

Withholding contraceptives from people unable to prove citizenship doesn't make sense from a federal spending perspective, Jaramillo said.

"It's a lot cheaper for me to provide a woman or man of reproductive age with family planning services than it is for society to absorb another child," she said.

Congress spent little time debating these consequences, said U.S. Rep. Peter DeFazio, D-Ore.

The main debate was the part of the bill that provided tax cuts for investors who own dividend-producing stocks, DeFazio said.

Republican leaders figured that nationally tens of thousands of illegal residents were illegally receiving Medicaid benefits. The Congressional Budget Office estimated that cutting them from the rolls could save the government $220 million over five years.