Rule leaves some without Medicaid

More than 1,100 low-income North Carolinians have been denied or cut off from Medicaid under a recent federal law that requires proof of U.S. citizenship.

The federal Deficit Reduction Act provision on Medicaid went into effect in September in the state. Since then, people in North Carolina who have applied or reapplied for Medicaid must present an official birth certificate or other "satisfactory documentary evidence" of their birthplace and citizenship status.

"I don't think it's really having the effect that was supposedly intended, to catch people who are not U.S. citizens," said Maria Eason, program manager for the Children's Health Program for Wake County Human Services. "I just got off the phone with a pregnant lady. She was born in Durham County and doesn't have the money to get a birth certificate."

Mark Benton, senior deputy director of the Division of Medical Assistance, said state officials knew it would take a major effort to meet the new requirement. Still, he said, with 1.6 million North Carolinians receiving Medicaid, cutting 1,130 people statewide was not a "very large number."

"If the purpose of the law is to ferret out people who are not citizens, we don't believe we have a significant problem with that," he said. "We were doing a very good job of checking credentials."

Even before the new law went into effect, county officials frequently required proof from people whose citizenship was in doubt.

"They always have had to prove citizenship ... if we questioned it," said Liz Scott, director of adult economic services at Wake County Human Services.

Now social service workers across the state have been handed a new duty: sending off for hundreds of birth certificates for applicants. In Wake County alone, human services workers are sending more than 500 requests a month to state and county agencies for recipients' birth certificates, sometimes waiting weeks to get replies from other states.

"We are concerned with otherwise eligible people not getting benefits because they can't get hold of a birth certificate," said Tom Bennett, who represents the state's directors of county social service departments.

Despite knocking more than 1,100 people out of Medicaid eligibility, the program for poor and disabled people has still posted more than a 5 percent increase in recipients compared with this time last year, according to Human Services statistics.

No one should have been denied coverage yet, however, according to a Charlotte-based advocate for low-income North Carolinians. Recipients were supposed to have had as long as a year to obtain a birth certificate or other proof of citizenship, said Doug Sea, an attorney with Legal Services of Southern Piedmont in Charlotte. Seay worked with the state on tweaking the federal requirements. "It looks like some of them were terminated or denied in error," he said.

Older people and those with disabilities are not typically among those affected because anyone with Medicare, Social Security or Supplemental Security Income benefits is presumed to be a U.S. citizen.

People in the United States illegally are eligible for Medicaid only in emergency situations.