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December 21, 2006 Leslie V. Norwalk, Esq. Re: Medicaid Coverage for Newborns Dear Ms. Norwalk: We, the undersigned organizations, are writing to express our concern about a directive contained in the Interim Final Rule to the Deficit Reduction Act (DRA) that will affect the health and well-being of citizen children. This directive appears in the preamble to the Interim Final Rule on citizenship and identification documentation published in the Federal Register on July 12th, 2006. According to the preamble, in the case of a child born in a U.S. hospital to a mother who is either a legal immigrant subject to the 5-year bar on Medicaid coverage or an undocumented immigrant, an application must be filed with proof of citizenship in order for the newborn to be covered by Medicaid (71 Fed. Reg. 39216). By paying for labor and delivery, the state Medicaid agency has already made the determination that the child was born in a U.S. hospital and is therefore a citizen. According to the U.S. Constitution, a baby born on U.S. soil is a citizen regardless of the immigration status of his or her parents. The directive in the preamble would effectively create two classes of citizen newborns based on the immigration status of their parents. The result of this discriminatory classification is that one group of newborns has automatic access to coverage while the other group of newborns is denied automatic access. The statement in the preamble is also inconsistent with federal Medicaid law. A 1984 law [Title 42 United States Code, Section1396a(e)(4)] provides that newborns whose mothers receive Medicaid at the time of birth can receive coverage immediately following delivery and up to one year after birth. Undocumented immigrants and documented immigrants who are barred from full Medicaid coverage for five years are eligible for emergency Medicaid for labor and delivery. Under the 1984 law, which remains unchanged, newborns whose mothers have received emergency Medicaid are automatically eligible for Medicaid. Several states, including Georgia, Kentucky, South Carolina, Tennessee, and Virginia, have already indicated that they will comply with the preamble directive.1 These states plan to deny automatic eligibility to newborns of undocumented and 5-year bar qualified documented immigrants. Other states may decide to follow their lead and implement the preamble directive. If implemented, the directive would result in substantial financial costs. Infants would be denied preventive care, including immunizations and well-child check-ups. Preventive care saves money, and blocking access to this care will cost state and federal Medicaid programs in the long run. Since the directive would prevent states from granting coverage until documentation of citizenship is provided, hospitals and physicians treating newborns will be at risk for delay or denial of reimbursement for the treatment of newborns who are low-birth weight, have post-partum complications or simply need well-baby care. Most important, the health of citizen children who are not able to access care will suffer. Without coverage, parents may forgo well-child and preventive care visits for their children. Infants who are born in U.S. hospitals and are U.S. citizens will be left without the care and coverage needed to prevent illness and death within the first year of life. The risk to the health of newborns from delays in coverage as well as from complete denials of coverage is unnecessary and harmful. The undersigned organizations work to improve the health of all women and their children, regardless of income or immigration status. We strongly urge CMS to reconsider the ramifications of the preamble directive. We are concerned that the directive will present substantial obstacles for low-income newborns and families. CMS has publicly encouraged groups or individuals to notify the agency about any denials of coverage. 2 However, this response is inadequate and will not ensure that newborns in immigrant families are able to avoid coverage delays or denials. Many immigrant families may not feel comfortable coming forward about denials or may have difficulties accessing the entire public health insurance system. Medicaid covers one in three U.S. births, and labor and delivery is one of the most important covered services for low-income women enrolled in the Medicaid program.3 For more than twenty years, infants of mothers who receive Medicaid coverage have been granted automatic coverage for one year after birth. Low-income women who qualify for either emergency or full-scope Medicaid coverage should be able to obtain seamless, timely and low-cost services for their children through the Medicaid program. We request that CMS continue to uphold the federal protection for infants and inform states that they should deem all infants born to mothers who have received emergency Medicaid for labor and delivery eligible for coverage. Sincerely, American Association of People with Disabilities cc:
Senator Max Baucus ________________________________________________________________________ Contact information: 1 Medicaid: some states denying automatic coverage to US born children of illegal immigrants. Bureau of National Affairs News. November 6th, 2006: Volume 11, Number 24. 2 Pear R. Medicaid wants proof of citizenship for newborns. New York Times. November 3, 2006. 3 Kaiser Family Foundation. Medicaid’s Role for Women. May 2006. Available at: http://www.kff.org. Accessed on November 27th, 2006. |
