Discriminatory Medicaid Provision

Recipient: Sen. William Frist

The Honorable William H. Frist
Senate Majority Leader
S-230 U.S. Capitol Building
Washington, DC 20515

Dear Senator Frist:

On behalf of the Leadership Conference on Civil Rights (LCCR), the nation’s oldest, largest and most diverse civil and human rights coalition, we write to bring to your attention a serious problem with a provision of the House budget reconciliation bill that would require U.S. citizens who apply for Medicaid to prove their citizenship status by, in most cases, providing a birth certificate or passport. This provision, which has received little public scrutiny to date, raises significant civil rights concerns and could effectively deny health care to large numbers of minority American citizens.

Proponents argue that the provision would prevent illegal immigrants from obtaining Medicaid by pretending to be citizens. But there is no evidence that such a problem exists. A comprehensive July 2005 study by HHS’ Office of the Inspector General found no substantial evidence that illegal immigrants are obtaining Medicaid by falsely declaring citizenship. (Legal immigrants already are required to present documentation of their status.)

This suggests that the savings from the provision — $735 million over ten years, according to the Congressional Budget Office — would come mainly from reducing enrollment among native-born U.S. citizens. Many low-income citizens do not have a birth certificate in their possession and do not have a passport. Under the House provision, they would be denied medical care through Medicaid solely for this reason.

Elderly African Americans are particularly likely to lack a birth certificate because many were born in an era when African Americans (especially in the South) had less access to hospitals due to racial discrimination. One study estimates that as many as one-fifth of African Americans born around 1940 lack a birth certificate. As a result, some low-income African Americans would likely be turned away from Medicaid even though they are eligible, and would lose access to vital health care services.

Most state Medicaid programs require documentation of citizenship when there is a reason to question an applicant’s status but do not require documentation for every single applicant, as the House provision would mandate. The HHS Inspector General’s study found no problems with states’ current approach. Forcing states to require documentation of all applicants also would increase state administrative burdens and is opposed by many state officials for that reason.

We strongly urge you to reject this unnecessary and inequitable provision. Thank you very much for your consideration. If you have any questions, please contact Nancy Zirkin, LCCR Deputy Director, at (202) 263-2880, or Rob Randhava, LCCR Counsel, at (202) 466-6058.

Sincerely,

Wade Henderson
Executive Director

Nancy Zirkin
Deputy Director