From the Virginia Health Care Foundation Newsletter Vital Signs, Winter 2007:

Unintended Consequences: The Impact of New Medicaid Citizenship Documentation Requirements on Virginia's Children

Among the requirements of the Deficit Reduction Act (DRA) of 2005 is a provision requiring documentation of citizenship and identity for all those applying for or renewing eligibility for Medicaid. This was added to prevent illegal immigrants from obtaining public benefits intended for U.S. citizens, a problem that has not been identified in Virginia. Instead, the new federal requirement has hampered Virginia's ability to enroll eligible, uninsured children.
After years of steady growth and an average net increase of 1000 children per month in the 12 months immediately preceding the implementation of the new requirements, there has been a dramatic decline in the number of children enrolled in Virginia's Medicaid program since the requirements took effect. Specifically, there has been a net decrease of 11,108 children enrolled in Virginia's Medicaid program in the first nine months of implementation (7/06 - 3/07).
In an effort to "look behind" the enrollment data and to understand the overall consequences of the documentation requirements, the Virginia Health Care Foundation (VHCF) contracted with Matrix Research Group to conduct a telephone survey of 800 adults who applied for Medicaid for their children after the requirements were implemented. VHCF also conducted interviews with Medicaid eligibility workers from around the state.
The study found that the new requirements have had a much broader impact than expected, adversely affecting thousands of citizen children since implementation last July. In addition to the significant decrease in the number of children enrolled in Medicaid, other unintended consequences include:
4-6 month delays in obtaining Medicaid coverage for Virginia children;
Inability of citizen children to obtain medical care; and
A dramatic increase in emergency room utilization by those caught up in lengthy eligibility determinations
While waiting for their health coverage to be approved, Virginia children have gone without needed medical care, including care for illness or injury, immunizations, dental care and prescription medications. All evidence indicates that these are US citizen children, born in U.S. hospitals, with more than two-thirds born in Virginia.
The new requirements have also had a serious impact on state and local agencies responsible for administering the Medicaid program, and have undermined Virginia's previously successful efforts to simplify and streamline application procedures.
Virginia's impressive progress in enrolling eligible children in the Medicaid program is being diminished by these requirements, and the health of thousands of Virginia's most vulnerable children is threatened.
Details about the study and its alarming results have been shared with Virginia's congressional delegates, as well as with the Centers for Medicare and Medicaid, the federal agency that administers Medicaid. We are hopeful that this overly restrictive policy will soon be changed.
For more information about the study, including a study brief and full study report, click here