January 20, 2006
Federal Update:
BIRTH-CERTIFICATE BLUES
more than one million off Medicaid
PLUS! This week, HW storms Capitol Hill...
|
OLDER BLACK FOLKS: Bill provision could cut many from Medicaid |
The budget conference agreement passed by the Senate just before the holidays packs many a nasty punch to Medicaid, SSI, TANF (welfare) and other programs relied upon by low-income Americans. But one aspect of the bill that could block benefits for over 1 million eligible Medicaid recipients has received little attention: a provision requiring that Medicaid recipients show a birth certificate or passort to demonstrate citizenship. (Over half of all Americans with HIV/AIDS rely on Medicaid for their health care.)
In its analysis of the provision, the Center on Budget and Policy Priorities (CBPP) notes that many populations of citizens may be pushed off the program by the provision—foremost among them elderly African-Americans, especially in the south, many of whom were born outside of hospitals due to poverty or discrimination and thus were never issued birth certificates. One study found that one fifth of African-Americans born in 1939-40 lacked birth certificates.
Other potentially affected groups include people who lost their birth certificates in Hurricane Katrina or other disasters, people who don't have ready access to such documentation, and the U.S.-born children of immigrants. Medicaid serves roughly 50 million Americans; CBPP estimates that if as little as 2 percent of those beneficiaries can't provide a birth certificate—which the provision would require them to do between July 2006 and July 2007—then up to 1 million recipients could be knocked off the program. The provision allows no exceptions, even for those with severe disability or impairments such as Alzheimer's disease or mental illness.
The provision—which has received relatively little media attention save an op-ed by New York Times columnist Bob Herbert—was spearheaded by Georgia Republican congressmen Nathan Deal and Charlie Norwood in an attempt to keep illegal immigrants off Medicaid. But an analysis of the inspector general's office of the Department of Health and Human Services (HHS) released last year found no evidence that great numbers of illegal immigrants were accessing Medicaid, which already stringently demands proof of legal immigrant status. The same study didn't recommend that Medicaid require proof of citizenship. The administrative costs of obtaining such records would also be burdensome for states, many of which are struggling for ways to control Medicaid costs.
LAST CHANCES
There is still the chance of amending the provision when the House takes up the conference bill again February 1, to respond to minor changes made to the Senate version. Matthew Broadus, a health policy expert for CBPP, says critics of the provision are trying to persuade at least one congressmember to introduce one or two very small technical amendments in the bill's language that would protect 10-15 percent of the recipients who may be affected by the provision—for example, those who are already eligible for SSI or Medicare. But, he says, "we don't feel there is much possibility of the entire provision being stripped."
Unless, that is, congressmembers can quickly be made to fully grasp the possible consequences of the provision if it goes through. "This is a month of a lot of learning for the House members, who didn't have much opportunity to see the bill in its entirety" before the voted for it, says Broaddus. "The best thing we can do is focus on moderate Republicans." Especially good targets are congressmembers who found an original version of the bill too harsh to vote for, then voted for it with changes. They include Jim Gerlach (PA), Nancy Johnson (CT), Walter Jones (NC), Jim Ramstad (MN), Christopher Shays (CT), Rob Simmons (CT) and John Sweeney (NY).
Apparently, no group has initiated an advocacy drive around the provision. So we'll start one here: Call your representative—especially if he or she is listed above—between now and February 1 at 202.224.3121 and tell them:
"When you take up the budget conference agreement on February 1, please strip out the provision requiring proof of citizenship for Medicaid eligibility—it will jeopardize coverage for up to 1 million needy U.S. citizens who lack a birth certificate or a passport."
We'll keep you posted on further developments.
HW and AAIM: THE HILL OR BUST!
 |
HILL'S ANGEL: HW's Bryant (left) and Mitchell (right) this week with Ann Gavaghan, AIDS staffer to Sen. Hillary Clinton (D-NY) |
This is a high-octane week for the whole Housing Works/AIDS Action in Mississippi (AAIM) advocacy team. Wednesday, HW federal advocacy director Robert Cordero accompanied HW's Larry Bryant and Alandra Mitchell and AAIM's Robin Webb and Almetha Williams on a whirlwind day of Hill visits to the entire Mississippi congressional delegation and to key members of the New York delegation—a total of 14 visits! Among the highlights was an actual half-hour face-to-face with Mississippi Sen. Trent Lott, who took a special liking to his state homegirl Williams and her tale of surviving HIV/AIDS and homelessness thanks to key federal programs.
In all 14 visits, everyone "drilled down" on key issues including Ryan White reauthorization, overall AIDS appropriations, fighting Medicaid cuts and how the current chaos surrounding the roll-out of the new Medicare drug benefit is affecting low-income dual-eligibles with HIV/AIDS. The Mississippi delegation even scouted for a Mississippi Republican sponsor to the HIV/AIDS Hurricane Emergency Relief Act (HR 4633)sponsored by Rep. Barbara Lee (D-CA) .
Thursday, the whole gang sat down before staffers from the Senate HELP Committee and the House Energy & Commerce Committee—the two bodies that oversee the Ryan White CARE Act (RWCA)—as part of a day-long session of community feedback to the president's RWCA reauthorization recommendations released last summer. Bryant and Mitchell delivered this feedback for HW; Webb and Williams delivered this feedback for AAIM. Theme #1 for both duos: Don't pit different parts of the country against each other in a fight for scarce RWCA resources! Fund the whole country—to the tune of $2.56 billion. (The Act has been flat-funded at about $2.1 billion for the past four years despite rising HIV/AIDS rates, especially in southern states.)
Others providing feedback on Thursday included New York City Health Commissioner Dr. Tom Frieden, who read this testimony supporting (not surprisingly) positions of benefit to New York City and other metropolitan areas.
Next week, we'll have a briefing on the both the feedback sessions and Hill visits—and photos of our HW/AAIM superstars arm in arm with their favorite (and often not-so favorite) congressional delegates. Stay tuned...
AND FINALLY...
The Coalition for Health Funding asks your group to consider signing on to this letter asking President Bush and Congress to fund discretionary public-health programs in FY07 by the cost of inflation plus $1 billion to restore cuts made this year.
And the Southern AIDS Coalition and the Alabama Department of Public Health invite you to join on Friday, January 27, 3-5 PM EST, this satellite conference and live webcast addressing HIV/AIDS rates in the southern states.
That's it for this week. As we prepare to go live, we learn that Bush's PEPFAR czar Randall Tobias has just been named head of USAID, which already has global HIV/AIDS advocates very worried. More on that and other developments next week.