Undeserving

From Rivka at Respectful of Otters (who’s blogging again! Hopefully now with more cute baby pictures!), an article at the Washington Post about Medicaid documentation:

A Medicaid rule takes effect tomorrow that will require more than 50 million poor Americans to prove their citizenship or lose their medical benefits or long-term care.

Under the rule, intended to curb fraud by illegal immigrants, such proof as a passport or a birth certificate must be offered at the time a person applies for Medicaid benefits or during annual reenrollment in the state-federal program for the poor and disabled.

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.

Funny story: my granddad, who was born at home on a farm, had months of difficulty obtaining a passport after September 11. He suspects that it’s because of his birth weight, which I believe was thirteen pounds. He was asked to find a witness to his birth–over three-quarters of a century ago. I have no difficulty believing that this will create huge problems for poor, homeless, alone, elderly, ill people.

Rivka feels the same way:

But it only seems reasonable if you haven’t had much contact with people living on the margins of American society. This rule affects homeless people who have only a garbage bag full of posessions to their names, and no idea where any of their relatives might be. People institutionalized because of mental illness or mental retardation. Elderly people born before all births were recorded – particularly elderly black Southerners, who were likely to be born at home due to Jim Crow hospital policies, and the rural elderly poor. People who are no longer able to communicate clearly due to disability. They don’t have passports. They may not know where they were born, or be able to communicate it to their caregivers.

Incidentally, it could also create problems for transpeople. Transsexuals cannot always obtain legal gender changes in their home states or on their passports (assuming they have them in the first place). Even those of us who are able sometimes cannot obtain legal recognition right away. We also sometimes opt not to disclose to our care providers because resulting transphobia would make the appointment a humiliating ordeal, or even compromise care. Forcing us to produce ID in order to receive treatment will make it more difficult for us to get treatment. It will probably cause some transsexuals to simply go without.

In comments on Rivka’s post, Teri points to another threatened population:

Thank you. I’m on the Board of Directors for a small social service agency that works with women and children victims of domestic violence and sexual assualt in rural southeastern MN and this requirement is also likely to effect men and women fleeing abusive relationships. One of the biggest reasons people don’t leave an abusive relationship is uncertainty about how they’ll take care of themselves; while safety planning can do a lot to help alleviate that fear and empower “victims”, it’s not always feasible. Knowing about this requirement will help the advocates who help these individuals plan ahead to be sure their documentation is available somewhere safe, even if that place is not their home.