By Dave Ranney
KHI News Service
Monday, Nov. 20, 2006
Thousands of children and pregnant women are being dropped or kept from the state”s Medicaid and HealthWave rolls for not being able to show proof of identification and citizenship as required by a new federal law aimed at illegal immigrants.
But Kansas officials are concerned the new law is off-target, screening out legitimate beneficiaries and dumping costs and problems on hospital emergency rooms.
“Worst case scenario
we may lose 20,000 beneficiaries before the slipping stops,” said Scott
Brunner, chief financial officer at the Kansas Health Policy Authority.
It”s only a matter of time, Brunner said, before these uninsured
children and pregnant women, mostly begin showing up in emergency rooms and clinics for the poor.
The trend flies in the face of Authority efforts to reduce uncompensated care in the state.
Health authority member E.J. “Ned” Holland Jr., senior vice president for human resources at Embarq, (formerly Sprint) compared the new law”s consequences to “moving money around inside the Titanic.”
Holland bristled at a projection that showed the state would save about $10 million by having fewer people on its Medicaid and HealthWave rolls.
“That”s just silly,” Holland said. “Those costs are just going to come out someplace else.”
Since July 1, families applying for Medicaid or signing up for HealthWave, the state”s health insurance program for the working poor, have been required to show proof of identification and U.S. citizenship.
The requirement is part of a federal initiative aimed at curbing illegal immigration.
Brunner said it”s not yet clear how many of those being kept from the Medicaid and HealthWave rolls are immigrants legal or illegal.
But there”s reason to suspect the new law is affecting non-immigrants more than immigrants, he said.
“Anytime you add an eligibility requirement, it has a chilling effect on enrollment,” Brunner said.
Most of the denials, he said, appear to be driven by families not having the documents
needed to prove citizenship
a birth certificate, for example
rather than their immigration status.
“These are not just immigrants,” he said, “these are Kansas kids.”
Brunner said between July and September, the new law kept 1,174 children and pregnant women from being added to the Medicaid and HealthWave rolls.
Another 1,552 were dropped when they could not produce required identification or citizenship papers during annual eligibility reviews.
“During that period of time, we had about 27,000 reviews and applications,” Brunner said. “About 2,700
or 10 percent
were denied due to citizenship and identification issues.”
Another consequence of the new law: The number of calls, faxes and filled-out forms at the state”s processing center in Topeka has skyrocketed.
Because the mandate caught the state unaware, there”s no money in the budget for additional staff to offset the increased workload at the processing center.
“The forms and faxes coming in have doubled or tripled, depending on the month. The number of calls went up six-fold,” Brunner said. “But the processing staff has remained at 16.”
Medicaid applications that once took 15 to 20 days to process now take almost 45 days.
“That”s significant because the law says processing can”t take more than 45 days,” Brunner said.
Ineffective?
According to Penney Schwab, executive director at the at the United Methodist Mexican American Ministries clinic in Garden City, the law is having little or no effect on illegal immigration.
“Our clients who are not citizens do not apply for Medicaid or HealthWave because receiving government services they”re not entitled to can be a permanent bar to legal entry,” she said.
Instead, Schwab said, immigrants turn to the clinics for free care.
The same is true in northeast Kansas, said Belinda Lewis, director of policy advocacy and research at El Centro, a social service and community development organization based in Wyandotte and Johnson counties.
“Before this rule change took effect,” Lewis said, “there was absolutely no evidence that we had any kind of problem with people getting benefits for which they were not eligible.
“So we enacted a policy to solve a problem that was dubious at best and, in the process added fuel to what is very obviously a significant problem,” she said.
The reduction in enrollees and likely shifting of uncompensated treatment costs to clinics and emergency rooms has created a new set of worries.
At the Grace Medical Clinic in Wichita, Executive Director Dave Sanford warned that few clinics can afford a reduction in their Medicaid receipts.
“We”re a not-for-profit,” Sanford said. “We use our Medicaid revenues to fund the care we provide the uninsured. Without that revenue, we”d have a real cash-flow problem.
“It would be hard to keep the doors open,” he said. “We”d have to look for other resources, which, I”m afraid, aren”t really there.”
There”s not a lot the health authority can do to remedy the situation, Brunner said.
“We can”t change the requirement, it”s federal law,” he said. “But we can do some things to make sure the system is working properly.”
Brunner said he hopes to find some money to hire additional workers for the processing center.
“We”d like to get the backlog down to a point that”s more manageable,” he said.
Contact Dave Ranney at
dranney@khi.org
or (785) 233-5443.