California will not begin enforcing the July 1 deadline for requiring Medicaid recipients to prove they are U.S. citizens because the state needs more time to notify its 58 counties on enforcement guidelines.
   The earliest enforcement could likely begin is early fall, says Sarah Olivia Mercer, senior program manager with the San Francisco-based Latino Issues Forum.
    At a June 29 press briefing in San Francisco, Mercer and other health care advocates stressed that Medicaid recipients should not panic and that they have time to get the required documents to prove they are U.S. citizens. Advocates at the briefing, which was sponsored by the Asian and Pacific Islander American Health Forum (APIAHF), also encouraged Californians to continue or begin accessing Medicaid benefits.
    Many health care advocates fear that more stringent Medicaid citizenship documentation requirements would create a barrier for people who rightfully qualify for Medicaid coverage, especially low-income families, the elderly and minorities.
    The changes are part of the Deficit Reduction Act of 2005 (DRA) that President Bush signed into law in January of this year. The DRA aims to reduce the cost of federally funded entitlement programs and would require states to have proof of each recipient's citizenship status in order to receive Medicaid funding from the federal government.
   “Somebody who has Alzheimer's disease may not remember where they were born or where to get their passport. They may not have family,” Mercer says.
    Providing documentation may be prohibitive for low-income people who were not born in a hospital, born in rural communities or born out of state.
    The new requirements will disproportionately affect African- Americans, says Michael Lyon, a health care activist with the Gray Panthers and former biomedical technician with the San Francisco Health Department.
   "Blacks are poorer, so it's going to be harder for them to satisfy the requirements," Lyon says. "More [blacks] are dependent on Medicaid, they're sicker, have poorer living conditions and diet, greater stress, and had less access to health care during youth and adolescence."
    Mercer says the Medical program was complicated enough even before the new requirement was introduced, especially for Latinos and Asians with limited English-language skills.
   "Getting the required documentation can be a challenge for Asian Americans," especially for those Japanese Americans who were interned in concentration camps during World War II, says Yvonne Y. Lee, a consultant with APIAHF.
    Currently, most states accept signed self-declarations of citizenship, and many have developed additional steps to verify status. The Medicaid program validates beneficiaries' status through their Social Security numbers.
    The new rules set by the DRAwould require recipients to verify their citizenship status with documents such as a U.S. passport or birth certificate.
    According to a report by the Center on Budget and Policy Priorities, about one in every 12 U.S. adults with incomes below $25,000 do not have a birth certificate or passport, and one in 10 adults in that income bracket don't have identification for at least one of their children.
   “The cost of a passport is about $70,” Mercer says. “It is a hardship for families, especially for low-income families, to provide this kind of documentation.”
    Lea Brooks, spokesperson for the California Department of Health and Human Services, says they are asking the federal program for flexibility in proving citizenship status. “We are concerned there could be a major impact on citizens who, for whatever reason, do not have a birth certificate,” Brooks says. “We are especially concerned about seniors.”
    Advocates also worry the new rule may put undue burden on health care providers.
    The new law doesn't apply to non-citizens, who already follow a separate process to apply for health coverage through Medicaid. Hemi Kim, policy analyst at the APIAHF, says the new rule will have greater impact on eligible citizens than on people who don't qualify. “The immigrant population has already been providing their green card and proof of residency in a rigorous process to prove their status,” Kim says.
    The new law may also prove a barrier for families with mixed status -- for example, when some family members are citizens and some hold green cards.
   “Nothing has changed in terms of eligibility. It's another barrier to have to worry if one child will be eligible versus another child,” Kim says.
    Ellen Wu, executive director of the California Pan-Ethnic Health Network, says creating barriers to receiving service is a common budget-cutting strategy on the part of the federal government during times of deficit.
    CPEHN's policy director Martin Martinez asserts, “The poor are going to pay for all the grandstanding” by federal lawmakers.
    California is one of 16 states where more than 1 million Medicaid beneficiaries would be required to submit new paperwork to receive or stay in the program. Around 8.2 million people in the state are enrolled in the program.
    To find out more about medical eligibility requirements, contact Medical of Healthy Families at (888) 747-1222; Access for Infants and Mothers at (800) 433- 2611; or Family Planning Services at (800) 942-1054.