Medicaid Citizenship Documentation Rule Cited As Main Cause of Medicaid Enrollment Drop
Monday, October 15, 2007
- Organization: The Bureau of National Affairs
Thursday, October 11, 2007
Medicaid Citizenship Documentation Rule Cited As Main Cause of Medicaid Enrollment Drop
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Medicaid application processing delays under new citizenship documentation requirements are the main reason for a 0.5 percent decrease in Medicaid enrollment in 2007, the first drop in a decade, according to a Kaiser Commission study released Oct. 10.
Birth certificates and other proof of citizenship documents required under the Deficit Reduction Act of 2005 are largely responsible for the enrollment decline, according to the study, 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008.
Lead study author Vernon Smith said the last time the Medicaid program experienced a reduction in enrollment was in 1998, when enrollment declined 1.9 percent.
Three-quarters of the states (37) said the new documentation requirements had a negative impact on enrollment, Smith said. Thirty- five states said the requirements increased the time it took to process Medicaid applications and renewals. The new requirements also increased administrative costs for 45 states, the study found.
Burdens for Applicants and States
Kansas Medicaid Director Andrew Allison said an estimated 20,000 people in his state alone could not provide the citizenship documents and were, therefore, ineligible for Medicaid benefits, since the documentation requirements took effect in July 2006.
Speaking at a press briefing, Allison said the requirements had an impact on eligible citizens who could not find birth certificates proving they are Americans, people with children born in other states, and those who have to purchase new birth certificates. He added that in Kansas the impact is felt "especially by African American children."
Allison said the overall effect of the documentation requirements has been "to dissuade eligible American citizens" from applying for Medicaid.
States also faced administrative burdens and costs, he said, adding that Medicaid administrators in Kansas were "immediately inundated with paperwork and confusion" and that the state has spent "over $1 million to deal with backlog" in processing applications.
Improved Conditions Curb Spending
Medicaid spending in fiscal year 2007 grew "slowly," by 2.9 percent, the study said, citing a good economy and low unemployment as contributing factors.
"In hard economic times, states are under incredible pressure to restrain Medicaid spending growth, but when fiscal conditions improve, states look to restore some cuts and really focus on improvements," said Kaiser Commission on Medicaid and the Uninsured Executive Director Diane Rowland.
The study said states are now in a period of overall economic recovery, with their quarterly tax revenues growing more rapidly since 2005.
Planned Medicaid Program Expansions
The study said 42 states are planning to expand their Medicaid programs in 2007 and 2008, reflecting the study title As Tough Times Wane, States Act to Improve Medicaid Coverage and Quality: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008.
The states expect that the expansion and coverage enhancements will increase Medicaid spending by 6.3 percent in 2008, the study said, compared to the 2.9 percent spending growth in 2007.
Increased income limits or earned income disregards for the Medicaid program eligibility will be implemented in a total of 14 states and the District of Columbia. Those states are Alaska, Arizona, Colorado, Connecticut, Indiana, Iowa, Louisiana, Montana, New Mexico, Nevada, Ohio, Oklahoma, Vermont, and Wyoming.
Premium assistance is planned in Arkansas, Massachusetts, Nevada, New York, Oklahoma, and Utah. Coverage expansion for people with disabilities will begin in Delaware, Georgia, Idaho, Louisiana, Maine, Maryland, Montana, Nevada, New York, Ohio, Texas, and Virginia.
The study said Oklahoma and North Dakota will implement a 12-month guaranteed eligibility. Other expansion categories include coverage for youth moving out of foster care and expansions under family planning waivers.
Smith said state Medicaid directors view the Medicaid expansions as a way to address the health care needs of the reported 47 million Americans without health insurance.
"The 50-State Survey on State Budgets and Medicaid Policy Actions for Fiscal Years 2007 and 2008" is available at http://www.kff.org/medicaid/upload/7699.pdfEnd of article graphic <http://pubs.bna.com/ip/bna/lnnpubsimages.nsf/images/CommonArticle/$File/eod.gif/?OpenElement>
Medicaid Citizenship Documentation Rule Cited As Main Cause of Medicaid Enrollment Drop
<http://pubs.bna.com/ip/bna/HCE.NSF/733c080111c28e2a852564c500782286/$Body/0.51AC?OpenElement&FieldElemFormat=gif>
Medicaid application processing delays under new citizenship documentation requirements are the main reason for a 0.5 percent decrease in Medicaid enrollment in 2007, the first drop in a decade, according to a Kaiser Commission study released Oct. 10.
Birth certificates and other proof of citizenship documents required under the Deficit Reduction Act of 2005 are largely responsible for the enrollment decline, according to the study, 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008.
Lead study author Vernon Smith said the last time the Medicaid program experienced a reduction in enrollment was in 1998, when enrollment declined 1.9 percent.
Three-quarters of the states (37) said the new documentation requirements had a negative impact on enrollment, Smith said. Thirty- five states said the requirements increased the time it took to process Medicaid applications and renewals. The new requirements also increased administrative costs for 45 states, the study found.
Burdens for Applicants and States
Kansas Medicaid Director Andrew Allison said an estimated 20,000 people in his state alone could not provide the citizenship documents and were, therefore, ineligible for Medicaid benefits, since the documentation requirements took effect in July 2006.
Speaking at a press briefing, Allison said the requirements had an impact on eligible citizens who could not find birth certificates proving they are Americans, people with children born in other states, and those who have to purchase new birth certificates. He added that in Kansas the impact is felt "especially by African American children."
Allison said the overall effect of the documentation requirements has been "to dissuade eligible American citizens" from applying for Medicaid.
States also faced administrative burdens and costs, he said, adding that Medicaid administrators in Kansas were "immediately inundated with paperwork and confusion" and that the state has spent "over $1 million to deal with backlog" in processing applications.
Improved Conditions Curb Spending
Medicaid spending in fiscal year 2007 grew "slowly," by 2.9 percent, the study said, citing a good economy and low unemployment as contributing factors.
"In hard economic times, states are under incredible pressure to restrain Medicaid spending growth, but when fiscal conditions improve, states look to restore some cuts and really focus on improvements," said Kaiser Commission on Medicaid and the Uninsured Executive Director Diane Rowland.
The study said states are now in a period of overall economic recovery, with their quarterly tax revenues growing more rapidly since 2005.
Planned Medicaid Program Expansions
The study said 42 states are planning to expand their Medicaid programs in 2007 and 2008, reflecting the study title As Tough Times Wane, States Act to Improve Medicaid Coverage and Quality: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008.
The states expect that the expansion and coverage enhancements will increase Medicaid spending by 6.3 percent in 2008, the study said, compared to the 2.9 percent spending growth in 2007.
Increased income limits or earned income disregards for the Medicaid program eligibility will be implemented in a total of 14 states and the District of Columbia. Those states are Alaska, Arizona, Colorado, Connecticut, Indiana, Iowa, Louisiana, Montana, New Mexico, Nevada, Ohio, Oklahoma, Vermont, and Wyoming.
Premium assistance is planned in Arkansas, Massachusetts, Nevada, New York, Oklahoma, and Utah. Coverage expansion for people with disabilities will begin in Delaware, Georgia, Idaho, Louisiana, Maine, Maryland, Montana, Nevada, New York, Ohio, Texas, and Virginia.
The study said Oklahoma and North Dakota will implement a 12-month guaranteed eligibility. Other expansion categories include coverage for youth moving out of foster care and expansions under family planning waivers.
Smith said state Medicaid directors view the Medicaid expansions as a way to address the health care needs of the reported 47 million Americans without health insurance.
"The 50-State Survey on State Budgets and Medicaid Policy Actions for Fiscal Years 2007 and 2008" is available at http://www.kff.org/medicaid/upload/7699.pdfEnd of article graphic <http://pubs.bna.com/ip/bna/lnnpubsimages.nsf/images/CommonArticle/$File/eod.gif/?OpenElement>
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