WASHINGTON, June 28 (UPI) -- Illinois nursing home resident Ruby Bell, 95, was born in Arkansas in 1911. She has no photo identification, no passport, and her county did not even issue birth certificates when she was born -- but if she does not produce one of those items to prove her citizenship, she could become one of millions of Medicaid beneficiaries to lose their coverage on July 1.
That is why she is one of the plaintiffs in a lawsuit filed Wednesday in Chicago district court against a new Medicaid requirement included in the Deficit Reduction Act passed in February. Under the new rules, virtually all 50 million current Medicaid beneficiaries -- and future applicants -- who say they are United States citizens must provide original documents as proof.
"It is extremely stressful, scary and damaging even to put (Medicaid beneficiaries) through this," said plaintiffs' attorney John Bouman of the Sargent Shriver National Center on Poverty Law. "All of the plaintiffs are American citizens. They've never had a problem establishing citizenship."
Previously, Medicaid applicants were required only to check a box during enrollment stating they were citizens and then sign their application under penalty of perjury. If irregularities turned up - such as multiple individuals with the same Social Security number - states launched investigations. If the lawsuit is passed, that old procedure would again be in practice.
The lawsuit argues making beneficiaries who have already been approved re-demonstrate their eligibility with no reason is a violation of their constitutional right to due process.
"The constitution says once you have a vested right to a benefit of some kind, it can't be taken away from you without fair procedures," he said. "It's an arbitrary and whimsical thing for government to say 'we don't believe you anymore, prove it again.'"
A Medicaid spokesperson said the agency had not yet seen the lawsuit, but planned to continue its adoption of the new rules.
"We're implementing the law as we are instructed to do by the Deficit Reduction Act," Mary Kahn told UPI. "We don't have the discretion not to implement it."
The law will not affect only the elderly poor. Individuals with disabilities and low-income children also receive coverage through Medicare.
One of the plaintiffs is disabled by a series of strokes and cannot speak. The members of his church who take care of him are not even sure where to begin looking for his documentation, and he cannot tell them.
Another is a 17-year-old girl who was adopted by parents who do not have evidence she was born in the United States, and never received the formal adoption decree that would be required by the new Medicaid rules.
And the fact that Medicaid beneficiaries are, by definition, very low-income individuals will make obtaining the identification they need even more difficult, said Rachel Klein, deputy director of health policy at Families USA, a consumer advocacy group.
"Beneficiaries may have some documentation somewhere, but may not be able to get it in time, or be able to afford to get it from their states," she said.
After their care expenses are paid for, seniors in nursing homes receive $30 per month. Getting a new birth certificate can cost as much as $50, Klein said.
"It is clear that a large proportion of Medicaid recipients just won't be able to afford it at all."
In disaster situations, like that witnessed post-Hurricane Katrina, the requirement could prevent victims from accessing care. Many refugees from New Orleans, for example, either did not bring documents with them or they were destroyed, she said.
The changes have received a negative reaction from states, which must implement them or risk losing federal Medicaid matching funds.
The new requirements impose an additional barrier to enrolling eligible individuals in Medicaid - something many states have invested considerable effort in doing. They also know that any new requirement comes with an attrition rate that can be as high as 10 or 15 percent, meaning that eligible individuals will leave the program's rolls to rejoin the ranks of the uninsured.
Implementing the rules will likely impose an enormous administrative cost as states develop the infrastructure to sort through a tremendous amount of new paperwork -- a cost which by most estimates will be much greater than savings from winnowing out the few illegal aliens who receive Medicaid by claiming they are citizens.
And states have not had much time. The original text of the law allowed the Secretary of Health and Human Services to permit additional documents, and his final guidance was only given to states on June 9.
"The attitude among states is that this is actually an unfunded mandate," said Ron Pollack, executive director of Families USA.
Even if the lawsuit is not successful, Medicaid beneficiaries may still get a reprieve.
A bill amending the language in the Deficit Reduction Act is likely to be introduced in Congress this week, and an already-drafted technical correction bill for the act will also probably eliminate the requirement for seniors and the disabled.
