Monitoring the Effects of

the Medicaid Citizenship Documentation Requirement

— Getting Monitoring Activities Underway —

Now that the July 1 implementation date is upon us, one of the most important things advocates can do is to tell the story of how U.S. citizens are being affected by the new obstacles they face when applying for Medicaid or seeking to retain their Medicaid coverage. If we can find compelling ways to portray the hardships confronting individuals who are unable to meet the requirement we will be better able to help policymakers understand the serious ramifications and unintended consequences of the new requirement. In addition, by monitoring what happens to U.S. citizens as they try to secure the required citizenship and identity documents, we can learn a great deal about strategies that may help relieve the burden on individuals, as well as those that are particularly problematic.

Many concerned parties have important roles to play in monitoring the effects of the Medicaid Citizenship Documentation Requirement, and advocates can facilitate the process by coordinating efforts to track and report on the consequences of the new rule. There may be many approaches to gathering the critical information that frame a persuasive story. For starters, it is important to encourage community groups and institutions to help identify people with compelling personal stories to share. It is also critical, to the extent possible, to work with your state Medicaid agency to collect data that can be used to provide a context for what is happening to applicants, beneficiaries, providers and the agency itself.

To begin:

1. Convene a coalition of stakeholders — hospitals, health clinics, nursing facilities, managed care organizations, health care professionals, visiting nurses, outreach organizations, social services agencies, foster care organizations, disability groups, eligibility workers and others — willing to use their connections with people and data to track the effects of the Medicaid Citizenship Documentation Requirement. This group can work together to identify applicants and beneficiaries who have faced hardships as a result of the new requirement. Health care providers can contribute by recording relevant trends they may observe — for example, an increase in patients whose health conditions become aggravated or go untreated as a result of not being able to enroll in Medicaid or keep their Medicaid coverage, or an increase in ER visits.

· Devise a “blueprint” for developing personal stories so that key aspects of each story are fully and accurately described. For example:

— What conditions brought the person to the Medicaid program?

— What problems did the person encounter in gathering required documents?

— How much time and money did the person spend trying to obtain the required documents?

— Did the person find help or was he or she left to navigate the bureaucracy alone?

— Was the person denied Medicaid or was Medicaid eligibility delayed or terminated?

— How did the person’s health suffer as a result? Did the person face financial hardship?

Make sure you have secured permission from individuals willing to share their stories with the media or other public settings.

2. Meet with your state Medicaid agency and suggest ways they can help. State Medicaid agencies may be willing to provide data that will help convey the consequences of the Medicaid Citizenship Documentation Requirement. Caseload trends, including enrollment, terminations and new entries among key demographic groups can provide important insights. For example, enrollment of elderly and people with disabilities does not generally fluctuate, so sudden dips would suggest problems. Encourage the state Medicaid agency to add closure or denial codes to track the number of applications that are not completed and the number of beneficiaries whose Medicaid coverage is terminated because they lack citizenship documents. Increases in average processing times for applications and renewals caused by the documentation requirements could lead to a general slowdown in processing of all applications and renewals.

Next Steps

The Center on Budget and Policy Priorities will be providing additional ideas for monitoring the consequences of the Medicaid Citizenship Documentation Requirement. We will be expanding on how state data and other information can be used to explain the magnitude of the problems that are created by this new requirement and we will offer suggestions for media events to spotlight the harm to people in need of medical care.

Please send us your ideas and examples of successful activities so we can include them in the strategy materials we will share with everyone.