Assessing the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients: Results of a "Second Wave" Survey

It focuses on health centers, their history and contributions, and the major policy issues that affect health centers and the communities and patients they serve. The RCHN Community Health Foundation, founded in October 2005, is a not-for-profit operating foundation whose purpose is to support community health centers through strategic investment, advocacy, education, and cutting-edge health policy research. The only foundation in the country dedicated to community health centers, the Foundation builds on a 40-year commitment to the provision of accessible, high quality, community-based healthcare services for underserved, medically vulnerable populations. The Foundation's gift to the Geiger Gibson program supports health center research and scholarship. Executive Summary This report represents a " second wave " follow-up to a " first wave " study whose purpose was to measure the effects of the Deficit Reduction Act's citizenship documentation requirements on health centers and their patients. The earlier study, conducted six months after implementation, found that the law had a widespread impact, including delayed applications, interrupted enrollment, disruptions in care, and at least anecdotal evidence of a growth in the number of uninsured patients as a result of the denial or loss of Medicaid coverage. This " second wave " survey underscores the existence of serious, ongoing problems more than a year after implementation. Specifically, the second wave survey finds that: • Three-quarters of all health centers continue to experience significant problems with citizenship documentation barriers for one or more patient groups; among health centers experiencing problems, the situation appears to be worsening rather than lessening on key measures. • Documentation requirements appear to have particularly affected several specific patient categories, including pregnant women, children, patients new to the service area, and newborns. • About one-third of health centers report a longer and more difficult application and enrollment process. • Nearly one-half of health centers continue to report that Medicaid application and enrollment disruptions and delays continue to affect their ability to arrange for specialty care and many affected centers report increased costs associated with helping patients with application and enrollment problems. • Although regulatory changes issued in 2007 were intended to address the problem, a significant number of health centers continue to report enrollment delays affecting newborns. • Despite the fact that the DRA did not modify the State Children's Health Insurance Program (SCHIP) when administered as a separate program, fully one-third of health centers located in states with separate SCHIP programs, …