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Volume 12 Number 23 Six states that began tracking the effects of the new citizenship and identity verification requirements on Medicaid enrollment since they took effect in July 2006 are reporting enrollment drops and higher administrative costs, according to a study by the Center on Budget and Policy Priorities issued Feb. 2. The new requirement, which was part of the Deficit Reduction Act of 2005, is particularly difficult for children, who often do not have the required identify-verification documents, such as driver's licenses or passports, report author Donna Cohen Ross, an analyst at the center, said at a press briefing. Citizenship documentation can also be troublesome for applicants who do not reside in the state in which they were born, or for those in states without electronic vital records systems, she said. Prior to the requirement, all but four states permitted Medicaid enrollees to complete a declaration of citizenship, signed under penalty of perjury, in lieu of producing documentation. And those four states that required documentation accepted a much wider range of documents than the new rule, which also requires applicants to submit original documents and not photocopies, Cohen Ross said. The Center on Budget and Policy Priorities describes itself as "one of the nation's premier policy organizations working at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals." Six States Tracking Since Beginning The report makes assessments of changes the requirements have made to enrollment in Iowa, Kansas, Louisiana, New Hampshire, Virginia, and Wisconsin. All six states show significant declines in Medicaid enrollment and were chosen for the study because they began tracking enrollment changes when the requirement took effect, Cohen Ross said. "States have made substantial progress over the past decade in streamlining their Medicaid programs to make them more accessible," Cohen Ross said. This includes allowing mail-in and online applications, as well as the traditional in-person. "Early evidence suggests that the new rule is reversing some of that progress and harming vulnerable low-income children and families who are citizens." In Wisconsin, which has designed mechanisms specifically to track enrollment changes caused by the documentation requirement, and not other factors, has found that more than 14,000 Medicaid- eligible individuals were either denied enrollment or lost coverage in Medicaid between August and December as a result of the new rule. The remaining five states are all reporting enrollment declines, and data suggest that the new rule is a major factor, the report said. For instance, if a change in employment trends or the economy were causing the enrollment drop, then a parallel decline would be seen in a state's Food Stamp Program applications, but this has not occurred, the report said. Kansas reported that between 18,000 and 20,000 applicants and previous beneficiaries have lost coverage since the documentation requirement was implemented. Additional Workload Louisiana is reporting a 7,500-child drop over just two months in its Medicaid rosters during its back-to-school outreach effort, which usually boosts enrollment. In addition, the state reported that the additional workload generated by the new requirement is diverting the time and effort eligibility workers normally would spend helping beneficiaries through the renewal process. Prior to July 2006, Iowa reported steady increases in its Medicaid enrollment. Since the documentation requirement, however, its program has experienced "the largest decrease in the past five years," the report said, although it did not provide a specific number. In Virginia, the number of children on Medicaid declined by 12,000 from July through November, but then increased slightly in December. State officials said the increase suggests that eligible children who lacked the required documentation were approved after delays of many months, the report said. The majority of individuals in the state who have lost or been declined coverage were U.S. citizens, the report said. In New Hampshire, the state reported that the percentage of applications submitted with all the necessary documents in September of 2006 dropped by almost half, compared with the number in September 2005. If applicants do not supply needed documentation within 28 days, the state closes the application, and the number of applications closed for this reason has doubled, to 20 percent in August 2006. All six states studied reported increased administrative costs from the program. Illinois projects up to $19 million in increased staffing costs in the first year. The report is available.
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