In the midst of numerous proposals before the Senate regarding legislation concerning the legalization of illegal aliens has arisen a little known provision of the recently signed 2005 Deficit Reduction Act. On February 8, 2006, President George Bush executed a bill into law which now requires recipients of Medicaid benefits to provide either an original birth certificate or passport in order to apply for or to continue to receive their health care benefits, commencing July 1, 2006.

The Medicaid program, available to American citizens who fall into a specified low income bracket, provides health care to adults and children, as well as the elderly and those in nursing homes. While much hand wringing and spin continues in the U.S. Congress regarding how to best deal with the status of illegal aliens, which directly impacts costs of U.S. government entitlement programs, this new requirement has yet to be discussed. As the result of the newly passed Massachusetts universal health care plan, which will include the Medicaid program, the new provision was just publicly revealed.

However, the present requirements for Medicaid require no such documents, relying only upon a signature of the applicant to certify whether or not they are American citizens. And as a result of the unaccountability for Medicaid fraud abuse over the past several decades, the U.S. government may be penalizing the vast majority of law abiding citizens, according to numerous patient advocates. But the issue is more about the continuing lack of enforcement of U.S. immigration law rather than an attempt to cut down on Medicaid fraud.

According to Families USA, a consumer advocacy organization, the disabled, the mentally ill, the homeless, the elderly and the chronically ill will unfairly suffer as the result of this new proviso, as they would have difficulty accessing copies of birth certificates, and would be far less likely to own a U.S. passport. Therefore, they will be unfairly denied necessary health care beginning as early as July 1st. Meanwhile, hospital emergency rooms may still not turn away any person of any status nor may they ask the legal status of any patient, according to the Emergency Medical Treatment and Labor Act of 1985.

While patient advocates may be correct regarding the most vulnerable being put at risk, on balance it would seem that without addressing social services