Critics fear that the provision will have the unintended consequence of harming several million U.S. citizens who, for a variety of reasons, will not be able to produce the necessary paperwork. They include mentally ill, mentally retarded and homeless people, as well as elderly men and women, especially African Americans born in an era when hospitals in the rural South barred black women from their maternity wards.
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One plaintiff is Alphonso DeShields, who was born in his parents' home in Spartanburg, S.C., a few months after World War I began. For five years, he has lived in a nursing home in Northwest Washington. He has a severe heart condition, cancer and other ailments.
"With respect to each of the documents" Medicaid would have him supply, the lawsuit states, "Alphonso DeShields possesses neither an original of such a document nor a copy of such a document certified by the original issuing agency."
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Until now, Medicaid recipients have declared their citizenship, under penalty of perjury, without having to show evidence of it. States have been able to demand substantiation in suspicious cases. No longer will that process suffice.
New applicants will be affected immediately and will be denied benefits until they offer proof of citizenship. Current recipients will not have to back up their declarations until their first annual reenrollment, when they will have 45 to 90 days to do so, depending on their circumstances.
