Insiders Insight

As of July 1, Medicaid beneficiaries and applicants are required to provide documentation proving their citizenship. The measure is an effort to keep undocumented immigrants off the Medicaid rolls, but the new law may be detrimental to hospitals’ financial health.

Peter J. Cunningham, Ph.D.
Senior Fellow
Center for Studying Health System Change
Washington, D.C.

Some people might be afraid that if large numbers of Medicaid enrollees were thrown off the rolls—either rightly or wrongly—that it might lead to a surge in hospital emergency department use. I don’t think that is the case, because Medicaid enrollees’ ED use is already pretty high. If they were to lose their coverage, they wouldn’t use the ED any more or any less. The real problem for hospitals is that a lot of those Medicaid patients using the ED will no longer be able to pay for those visits. So the hospital would have to provide a lot more uncompensated care. It could potentially impact hospitals financially, but I don’t think it means their problems with crowded emergency departments are going to get any worse.

Stan Rosenstein
Deputy Director of Medical Care Services, California Department of Health Services
Sacramento, Calif.

Hospitals have to treat everybody who comes in the door with an emergency, so the new law could have an impact. In California, we are working closely with hospitals to develop ways to minimize these effects. For example, we are doing an electronic match of our birth certificate records—if someone was born in California, the state already has that person’s birth certificate, so we can produce that document for the provider. Another thing that would help hospitals is getting outstation Medicaid-eligibility workers. The outstation worker could assist in obtaining documentation while the patient is in the hospital. In general, I would encourage hospitals to work with their state Medicaid programs. We have a shared interest to make this implementation as easy as possible.

—Carrie Vaughan