THE DEFICIT REDUCTION ACT COULD HAVE BROAD CONSEQUENCES FOR MENTAL HEALTH CONSUMERS AND PROVIDERS BY CHARLES INGOGLIA, MSW
Governors, state legislators, members of Congress, providers, and Healthcare advocates have used Medicaid to meet a variety of healthcare needs. Indeed, Medicaid fulfills many roles. It is a health insurance program for 25 million children and 14 million adults, most of them low-income working parents. Medicaid is the largest purchaser of long-term care and personal care services for older Americans and the primary payer for community-based mental health services. Medicaid has proven to he a dependable and nimble healthcare program.
Yet not everyone is happy with Medicaid. There are conflicting calls for Medicaid to be more flexible m the services it offers, but more stable in its costs. Congressional budget reconciliation legislation, known as the Deficit Reduction Act (DRA) of 2005, has set the stage for a potentially massive upheaval of Medicaid, affecting both menial health consumers and providers.
The DRA is far-reaching legislation that touches many areas of federal spending and policy, including farm subsidies, student loan policy, Medicare, Medicaid, SCHIP, and others. The legislation passed the Senate only after Vice-President Cheney cast the tie-breaking vote. Because of a procedural move, the DRA had to pass the House twice-the second time it passed by only two votes. President Bush signed it into law on February 8, 2006.
The DRA includes a number of changes to Medicaid. Mandatory provisions include new proof of U.S. citizenship requirements and changes to case management. The legislation also creates a number of options for states regarding cost sharing, premiums, and benefit package design. Each of these changes could disrupt the services offered by community behavioral health agencies to persons with mental illness who qualify for Medicaid.
Proof of Citizenship
Effective July 1, 2006, all persons applying for Medicaid for the first time, as well as persons being recertified for Medicaid, must provide proof of U.S. citizenship. The statute indicates that the primary documents necessary to prove citizenship are U.S. passports or birth certificates. For naturalized citizens, naturalization papers would be accepted. The statute allows some flexibility for other documents and gives the secretary of the Department of Health and Human Services (HHS) some discretion in determining allowable documents. However, the statute indicates that allowable documents must be of a type that requires proof of citizenship when issued, effectively meaning birth certificates or passports.
Under current practice, most state Medicaid programs ask applicants to indicate if they are U.S. citizens and allow self-attestation as proof of citizenship. A state has the ability to investigate if it believes a person is not a U.S. citizen. Legal immigrants must produce written proof of their immigration status, but a recent report by the HHS Office of Inspector General (OIG) found no substantial evidence that illegal immigrants were claiming to be U.S. citizens and successfully enrolling in Medicaid. In fact, theOIG recommended against requiring applicants to produce U.S. citizenship documentation; the OIG suggests that since this is not a prevalent problem, it is not worth the time and money to require proof of citizenship.
For all practical purposes, all 51 million Medicaid beneficiaries will have to produce proof of U.S. citizenship sometime between July 1, 2006, and July 1, 2007, and at every recertification date in the future. There are no exceptions to this requirement. Therefore, persons displaced by natural disasters, persons in nursing homes, the homeless, and persons with serious mental illness all must produce proof of U.S. citizenship. This requirement presents a daunting challenge for Medicaid beneficiaries, as well as for case management staffwithin community mental health centers, for state Medicaid agencies, and for city and county offices charged with record maintenance. …