WASHINGTON – Under a new federal policy, children born in the United States to illegal immigrants with low incomes will no longer be automatically entitled to health insurance through Medicaid, Bush administration officials said yesterday.
Doctors and hospitals said the policy change would make it more difficult for such infants, who are U.S. citizens, to obtain health care needed in the first year of life.
Illegal 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, and states provided coverage 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 documentation requirements because some lawmakers were concerned that immigrants were fraudulently claiming U.S. citizenship to get Medicaid.
Marilyn 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.”
California has objected to the move.
S. Kimberly Belshe, secretary of the state's Health and Human Services Agency, said: “By virtue of being born in the United States, a child is a U.S. citizen. What more proof does the federal government need?”
About 4 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 unknown, but is likely to be in the tens of thousands, health experts said.
Doctors and hospitals denounced the policy change and said it was not required by the new law.
Dr. Jay Berkelhamer, president of the American Academy of Pediatrics, said the policy “punishes babies who, according to the Constitution, are citizens because they were born here.”
Dr. Martin 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,” 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 yesterday, Leslie 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,” 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.”
Under federal law, hospitals generally have to examine and treat patients who need emergency care, regardless of their ability to pay. So the new policy is most likely to affect access to other types of care, including preventive services and treatment for infections and chronic conditions, doctors said.
Rep. Charlie Norwood, R-Ga., was a principal architect of the new law. “Charlie's intent was that every person receiving Medicaid needs to provide documentation,” said John Stone, a spokesman for 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.”
Berkelhamer of the pediatrics academy disagreed.
Even though the children are eligible for Medicaid, he said, illegal immigrants may be afraid to apply because of “the threat of deportation.” And the policy “will cost the health care system more in the long run,” Berkelhamer said, because children of illegal immigrants may go without immunizations, preventive care and treatments needed in the first year 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.”
