Health insurance for hundreds of low-income Arizonans is in limbo, and thousands more await word that they’ve been reauthorized under a new federal requirement to prove U.S. citizenship.



The state has hired more than 80 new eligibility workers to scour databases, hospital records and other documents that would show where people were born or confirm their citizenship in other ways.

Since the law took effect July 1, no one has been denied coverage because they couldn’t show such proof, said Rainey Day Holloway, a spokeswoman for the Arizona Health Care Cost Containment System, the state’s version of Medicaid.

And state health officials have not yet set a deadline for the more than 5,200 cases they were working as of Sept. 30, she said.

But advocates for the poor, homeless and mentally ill fear that some Arizonans who are entitled to receive health care benefits eventually will be turned away because they can’t produce the right documents.

They also worry that others, including the U.S.-born children of foreign-born parents, won’t apply at all.

“You have people who are never going to be able to find their birth certificates, no matter what you do, or any proof of citizenship,” said Sherri Walton, executive director for the Arizona Mental Health Association. “So what do you do about them?”

The new law, part of the Deficit Reduction Act signed by President Bush in February, is intended to prevent illegal immigrants from receiving Medicaid benefits. But state and federal officials acknowledged it’s likely to snag U.S. citizens.

The Congressional Budget Office estimated that the law would save 0 million in the first five years and that roughly 35,000 people would lose coverage by 2015.

In Arizona, nearly 4,400 renewal applications were being reviewed, but Holloway said many of them were thought to be data entry errors.

Another 835 new AHCCCS applicants had not provided sufficient proof of citizenship, and under the law could not receive benefits until they did.

A huge hurdle was cleared days after the law took effect, when federal officials, barraged by complaints from the states, agreed to exempt elderly and disabled who also qualified for Medicare. That’s about 97,000 Arizonans.

Nursing homes and hospitals, in particular, breathed a sigh of relief. Many of their residents had once proved citizenship, but might be hardpressed to do so now.

Hospitals and behavioral health providers, however, remain concerned that they could be left paying the bills for patients who are deemed ineligible. And those who would have received preventive, ongoing services under AHCCCS may be forced to rely instead on more expensive emergency treatment.

“While people are saying today that they’re not going to lose services, this thing was called the Deficit Reduction Act for a reason,” said Trudy Rowe, chief financial officer for ValueOptions, which oversees Maricopa County’s behavioral health system.

“A hospital is not going to put them out on the street,” Rowe said. “But what happens after that emergency stay is of concern.”

Community Bridges, a Mesa-based detox and treatment center, has sent AHCCCS nearly 1,000 applications since July, only eight with the appropriate citizenship documents. Just 88 have been approved so far, said chief executive officer Frank Scarpati. Federal requirements make states responsible for helping people track down the necessary documents. Health care providers say they rarely have the time.

“Nothing’s really changed for the people that we work with,” Scarpati said. “They’re not going to show up with a birth certificate or an ID card.”

In the past, Medicaid applicants in Arizona and most other states were required to sign an affidavit swearing they were U.S. citizens, and state employees routinely checked Social Security numbers against a federal database. They would also request citizenship documentation for those they believed to be foreign-born.

Federal guidelines give people a “reasonable opportunity” to find the documents as long as they are making a “good faith” effort. Some states have put strict deadlines on those terms and have already denied applicants because they could not prove citizenship. Others have not even begun to implement the law.

There are many ways to crunch the numbers, and ups and downs from month to month, but early AHCCCS enrollment figures appear to be down.

From June to October, there were 7,000 fewer enrolled in the county’s behavioral health program, and AHCCCS numbers overall have declined by roughly 15,000 since July 1.

More than 1 million people, or nearly one in five Arizonans, are covered by the lowincome health care program.

Kim Van Pelt of the Children’s Action Alliance said the state has done a good job of informing people about the new requirements and training workers.

“The state has been about as proactive as it could be,” she said. “We’re happy so far that people aren’t being declined for coverage.”

But with one out of four children in Arizona living with a foreign-born parent, Van Pelt said children may not get the health care they’re entitled to.

“Our fear is that this is just serving as a barrier,” she said. “It’s really more about trying to keep people off coverage as opposed to cracking down on illegal immigration.”

Contact Mary K. Reinhart by email, or phone (480) 898-6867