Impact of the New Citizenship Requirements on Receipt of Medicaid in Vulnerable Populations

New citizenship and identification documentation requirements may be a barrier for children and families trying to access Medicaid. The purpose of this study is to describe the impact of federal policy on children's access to Medicaid. The Federal Deficit Reduction Act of 2005 created new enrollment requirements, including providing original citizenship and identification documents. For eligible children in low income families, obtaining original documents may be an economic hardship because of fees, and there may be transportation problems keeping required face-to-face enrollment interviews. We designed a seven question survey to monitor the effects of this policy by interviewing parents of pediatric patients. Items include whether they applied for Medicaid; whether they were denied or granted coverage; whether they were aware of the new policy; and whether the policy discouraged them from applying. The survey was implemented at four mobile medical clinics (in Washington DC, rural WV, Dallas TX and Biloxi MS) during February 2008. These programs serve demographically diverse low income populations, most of whom are Medicaid eligible. Preliminary anecdotal evidence reveals multiple barriers to obtaining Medicaid including potentially punitive policy changes in WV, restrictive enrollment procedures in MS, and an emerging onerous burden caused by the new citizenship documentation requirements. A preliminary review of historical Medicaid data at the implementation time period of the new requirements reveals a dip in enrollment in some states. It is expected that the survey results will elucidate barriers to enrollment and verify that the documentation requirements impede health insurance coverage for eligible children.