November 2, 2006
U.S. Tightens Medicaid Rules for Babies of Illegal Immigrants
By ROBERT PEAR
WASHINGTON, Nov. 2 — Under a new policy, children born in the United
States to undocumented immigrants with low incomes will no longer be
automatically entitled to health insurance through Medicaid, federal
officials said today.

Doctors and hospitals said the policy change would make it more difficult
for such infants, who are United States citizens, to obtain health care
needed in the first year of life.

Undocumented immigrants are generally barred from Medicaid, but can get
coverage for treatment of emergency medical conditions, including labor
and delivery. In the past, once a woman received emergency care under
Medicaid for the birth of a baby, the child was deemed eligible for
coverage as well, and states had to cover them for one year from the date
of birth.

Under the new policy, an application must be filed for the child, and the
parents must provide documents to prove the child’s citizenship.

The documentation requirements took effect in July, but some states have
been slow to enforce them, and many doctors are only now becoming aware of
the effects on newborns.

Obtaining such documents can take weeks or months in some states, doctors
said. Moreover, they added, illegal immigrant parents may be reluctant to
go to a state welfare office to file applications because they fear
contact with government agencies that could report their presence to
immigration authorities.

Administration officials said the change was necessary under their reading
of a new law, the Deficit Reduction Act, signed by President Bush in
February. The law did not mention newborns, but generally tightened
Medicaid documentation requirements because some lawmakers were concerned
that immigrants were fraudulently claiming United States citizenship to
get Medicaid.

Marilyn E. Wilson, a spokeswoman for the Tennessee Medicaid program, said:
“The federal government told us we have no latitude. All states must
change their policies and practices. We will not be able to cover any
services for the newborn until a Medicaid application is filed. That could
be days, weeks or months after the child is born.”

About four million babies are born in the United States each year, and
Medicaid pays for more than one-third of all births. The number involving
illegal immigrant parents is not known, but is likely to be in the tens of
thousands, health experts said.

Doctors and hospitals denounced the policy change and denied that it was
required by the new law.

Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics,
said the new policy “punishes babies who, according to the Constitution,
are citizens because they were born here.”

Dr. Martin C. Michaels, a pediatrician in Dalton, Ga., said that
continuous coverage in the first year of life was important because
“newborns need care right from the start.”

“Some Americans may want to grant amnesty to undocumented immigrants, and
others may want to send them home,” Dr. Michaels said. “But the children
who are born here had no say in that debate.”

Under a 1984 law, which remains on the books, infants born to pregnant
women on Medicaid are deemed eligible for Medicaid for one year.

In an interview today, Leslie V. Norwalk, acting administrator of the
Centers for Medicare and Medicaid Services, said the new policy “reflects
what the new law says in terms of eligibility.”

“When emergency Medicaid pays for a birth,” Ms. Norwalk said, “the child
is not automatically deemed eligible. But the child could apply and could
qualify for Medicaid because of the family’s poverty status. If anyone
knows about a child being denied care, we want to know about it. Please
step up and tell us.”

Representative Charlie Norwood, Republican of Georgia, was a principal
architect of the new law. “Charlie’s intent was that every person
receiving Medicaid needs to provide documentation,” said John E. Stone, a
spokesman for Mr. Norwood, who is a dentist and has been active on health
care issues. “With newborns, there should be no problem. All you have to
do is provide a birth certificate or hospital records verifying birth.”

But Dr. Berkelhamer of the pediatrics academy disagreed. Even though the
children are eligible for Medicaid, he said, undocumented immigrants may
be afraid to apply because of “the threat of deportation.” And the new
policy “will cost the health care system more in the long run,” added Dr.
Berkelhamer, because children of undocumented immigrants may go without
immunizations, preventive care and treatments needed in the first year of
life.

Dr. Joshua M. Sharfstein, commissioner of the Baltimore Health Department,
said: “From the standpoint of public health, the new policy is senseless.
It creates delays in getting insurance for children at precisely the
moment when they need it most, in the first few months of life.”

Anne Marie Murphy, the Medicaid director in Illinois, said: “The new
policy will be a barrier to Medicaid enrollment for citizen children. If
we pay medical claims for childbirth at a hospital in Illinois, we know
that the child was born here and is eligible for our program, based on
income. It would be physically impossible for the child not to be a
citizen.”

Doctors, children’s hospitals and advocacy groups, like the National
Health Law Program, have been urging states to preserve the old policy on
Medicaid eligibility for children born to undocumented immigrants.

Sara Rosenbaum, a professor of health law at George Washington University,
said: “The new policy reflects a tortured reading of the new law and is
contrary to the language of the 1984 statute, which Congress did not
change. The whole purpose of the earlier law, passed with bipartisan
support, was to make sure that a baby would not have a single day’s break
in coverage from the date of birth through the first year of life.”

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