[Congressional Record Volume 153, Number 36 (Friday, March 2, 2007)]
[Senate]
[Pages S2561-S2562]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY:
  S. 751. A bill to amend title XIX of the Social Security Act to 
modify certain administrative eligibility rules relating to children 
born in the United States to Medicaid-eligible mothers; to the 
Committee on Finance.
  Mr. GRASSLEY. Mr. President, I am pleased today to introduce the 
Guaranteed Access to Medicaid for Newborns Act. This bill corrects a 
problem that has arisen during the implementation of the Deficit 
Reduction Act, DRA, of 2005. Through this act, we will guarantee that 
children born in America who are eligible for Medicaid can seamlessly 
get Medicaid coverage.
  For the last two decades, Medicaid recipients have been required to 
be a U.S. citizen or qualified alien who has been in the country for at 
least 5 years. In a July 2005 report, the HHS Office of Inspector 
General found that 47 States allowed individuals to ``self attest'' 
their citizenship status to qualify for Medicaid benefits. In short, 
the State simply asked a Medicaid applicant if they were a citizen. The 
applicant need only respond, ``Yes, I am an American.'' No documents 
necessary. And of those 47 States, 27 did no followup verification such 
as checking with the Social Security Administration. In response to 
this report, the DRA included a House-led provision that I supported to 
require States to more carefully document the citizenship of Medicaid 
recipients and applicants.
  Implementation of this provision, as is often the case with 
legislation, has not been without its challenges. The interim final 
rule that was issued by CMS effective July 6, 2006, did make many 
improvements so that the new statute could be implemented consistent 
with legislative intent. I think, on the whole, CMS did a good job. 
However, there was one specific provision in the interim final rule 
that I do not think is consistent with congressional intent: the 
provision that makes it more difficult for children born to 
undocumented mothers to gain Medicaid eligibility.
  In section 1903(v) of the Social Security Act, the Medicaid statute 
makes available payment to States for treatment of an alien who is not 
otherwise eligible for Medicaid in the case of an emergency medical 
condition. A woman who is undocumented or not

[[Page S2562]]

otherwise eligible for Medicaid is covered under Medicaid for labor and 
delivery. Nothing in the DRA changed that nor was anything in the DRA 
intended to change that.
  Under section 1902(e)(4) of the Social Security Act, a child born to 
a woman receiving Medicaid at the time of the child's birth is deemed 
onto Medicaid for a year. States had been interpreting that to mean the 
child of a woman who was undocumented could be deemed onto Medicaid for 
a year since the mother, under 1903(v), was eligible for Medicaid at 
the time of the child's birth. The interim final rule now specifically 
prevents a State from deeming the child of an undocumented mother onto 
the State Medicaid program without properly documenting the child's 
citizenship first.
  In this case, I believe CMS has gone too far. A child born in the 
United States of America is a citizen. Before the DRA, children born to 
mothers on Medicaid were deemed onto Medicaid, and I think that is 
absolutely in the best interest of that newborn child. The DRA did not 
change two fundamental facts: First, the mother, regardless 
of documentation status, was eligible for Medicaid at the time of the 
child's birth and, second, the child is a citizen. In my mind, there is 
no reason then to have any new documentation requirement for the child.

  The legislation I am introducing today reinstitutes the pre-DRA 
policy with one notable exception. Under the old rule, a State could 
issue a temporary Medicaid identification number to the mother which 
served as the identification number for the child for up to a year. I 
don't think that it's necessary or appropriate for a State to provide a 
child Medicaid benefits by issuing the mother a Medicaid card. This 
especially problematic in cases where the mother may not be in the 
country legally nor eligible for Medicaid after delivery. My 
legislation changes the old policy by requiring the State to issue an 
identification number to the child of the undocumented mother. This 
does not in any way change the States' responsibility to provide the 
mother benefits when she comes to the emergency room in labor.
  The legislation makes one further change to the statute to benefit 
newborns. Under the interim final rule, all children born to mothers on 
Medicaid are required to document their citizenship within 1 year of 
birth. I do not think that is necessary. Medicaid paid for the birth of 
an American citizen. It is simple common sense that the child is a 
citizen and requiring any further documentation is redundant and 
counter-intuitive.
  I want to be clear that I support the requirement that a State more 
fully document the citizenship of applicants for Medicaid. Given what 
the Congressional Budget Office has told us would be the cost of making 
undocumented aliens eligible for public programs, the Deficit Reduction 
Act addressed a real concern by requiring documentation. I want the new 
statutory provision to go forward to ensure that the people getting the 
benefits are actually eligible for the benefits. However, CMS and the 
States should recognize what is to me, common sense: A child born in 
the United States whose birth was paid for by Medicaid is a citizen 
under current law. No further documentation necessary.
                                 ______