[Congressional Record (Bound Edition), Volume 152 (2006), Part 10]
[Senate]
[Pages 13056-13057]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   MEDICAID DOCUMENTATION REQUIREMENT

  Mr. DURBIN. Madam President, it has been less than 4 months since 
passage of the Deficit Reduction Act. That bill cut Medicaid health 
benefits for our Nation's low-income children, seniors, pregnant women, 
and people with disabilities.
  One provision of the bill requires Medicaid beneficiaries to present 
a passport or birth certificate as proof of citizenship before they are 
eligible for benefits or to renew their benefits.
  All States had the legal authority to require beneficiaries to 
furnish these documents before we passed the Federal law. However, 47 
States have made the decision not to require that identification of 
Medicaid recipients.
  Many low-income Americans don't have these documents, and most States 
have decided that requiring them would create a hardship and a barrier 
to health care for some of the poorest people in America.
  Instead, States allowed written self-declaration of citizenship and 
had what are called prudent person policies in place if State personnel 
were suspicious and wanted further proof.
  The inspector general of the Department of Health and Human Services 
conducted a review of these self-declaration policies and found that 
most

[[Page 13057]]

States that conducted post-eligibility quality control measures have 
not found any problems with self-declaration of citizenship. The system 
was working.
  Nevertheless, Congress passed the documentation requirement which 
will go into effect on Saturday, only 3 weeks after the Department of 
Health and Human Services sent guidelines out to the States. That is 
hardly adequate time to implement a very difficult provision.
  This is going to hurt a lot of vulnerable Americans. Foster children 
who met citizenship requirements to enter the foster care system will 
have to go out and prove that they are Americans.
  The 850,000 Alzheimer's patients on Medicaid will have to somehow 
locate these documents or run the risk of losing Medicaid protection.
  Nursing home residents, 75 percent of whom have some cognitive 
impairments, such as Alzheimer's or Parkinson's or dementia, are going 
to have to come up with citizenship documents or be cut off from 
Medicaid.
  For example, Kevin Harris, who lives in Chicago, is blind and 
mentally impaired. Kevin does not have a birth certificate, and his 
legal guardian does not know where to begin looking because Kevin 
doesn't remember where he was born. As of Saturday, Kevin will have to 
find his birthplace or he will become ineligible for health benefits 
when it comes time to renew.
  At the very least, States should have more time to work with these 
unfortunate individuals who are struggling with serious medical 
illnesses. Throwing these paperwork requirements at people who are 
struggling to live day to day is not right.
  The Akaka bill, sponsored by the Senator from Hawaii, which I am 
proud to cosponsor, will allow States to delay implementation of this 
rule until January 31 of next year. It will give them an additional 6 
months to at least get this in place. That will give all of those 
involved time to figure out how to avoid letting people like Kevin 
Harris lose health care protection in America

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