However, Mr. Chairman, we must ensure that individuals are not unfairly denied treatment in the name of a fraud crackdown especially since provider fraud is much more prevalent than beneficiary fraud. The Deficit Reduction Act contained a provision which will require individuals applying or reapplying for Medicaid to verify their citizenship through additional documentation requirements. I have introduced legislation, S. 2305, to repeal these burdensome documentation requirements for individuals applying or reapplying for Medicaid to verify their citizenship.

We must repeal this provision before it goes into effect July 1, 2006, because it will create barriers to health care, is unnecessary, and will be an administrative nightmare to implement. For most native-born citizens, these new requirements will most likely mean that they will have to show a U.S. passport or birth certificate. The Center on Budget and Policy Priorities estimates that more than 51 million individuals in this country will be burdened by having to produce additional documentation. In 16 states, Arizona, California, Florida, Georgia, Illinois, Louisiana, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Texas, and Washington, more than a million Medicaid beneficiaries will be required to submit the additional documents to receive or stay on Medicaid. In Hawaii, an estimated 200,000 people who are enrolled in Medicaid will be required to produce the additional documentation. The estimate for Oklahoma is 654,000 people.

The requirements will disproportionately impact low-income, racial and ethnic minorities, indigenous people, and individuals born in rural areas without access to hospitals. Due to discriminatory hospital admission policies, a significant number of African-Americans were prevented from being born in hospitals. Data from a survey commissioned by the Center on Budget and Policy Priorities is helpful in trying to determine the impact of the legislation. One in 12 U.S. born adults, who earn incomes of less than $25,000, report they do not have a U.S. passport or birth certificate in their possession. Also, more than 10 percent of U.S.-born parents, with incomes below $25,000, do not have a birth certificate or passport for at least one of their children. An estimated 3.2 to 4.6 million U.S.-born citizens may have their Medicaid coverage threatened simply because they do not have a passport or birth certificate readily available. Many others will also have difficulty in securing these documents, such as Native Americans born in home settings, Hurricane Katrina survivors, and homeless individuals.

Mr. Chairman, you understand the difficulty in gaining access to health care. Having to acquire a birth certificate or a passport before seeking treatment will create an additional barrier to care. Some beneficiaries may not be able to afford the financial cost or time investment associated with obtaining a birth certificate or passport. The Hawaii Department of Health charges $10 for duplicate birth certificates. The costs vary by state and can be as much as $23 to get a birth certificate or $97 for a passport. Taking the time and obtaining the necessary transportation to acquire the birth certificate or a passport, particularly in rural areas where public transportation may not exist, creates a hardship for Medicaid beneficiaries. Failure to produce the documents quickly may result in a loss of Medicaid eligibility.

Further compounding the hardship is the failure to provide an exemption from the new requirements for individuals suffering from mental or physical disabilities. Those suffering from diseases such as Alzheimer's may lose their Medicaid coverage because they may not have or be able to easily obtain a passport or birth certificate.

It is likely these documentation requirements will prevent beneficiaries who are otherwise eligible for Medicaid to enroll in the program. This will result in more uninsured Americans, an increased burden on our healthcare providers, and the delay of treatment for needed health care.

Just last Friday, while visiting Kapiolani Medical Center for Women and Children in my home state of Hawaii, I met with a mother who said if it wasn't for Medicaid benefits, her special-needs child would not have the level of care he is getting now at Kapiolani. Parents who are dealing with the hardships of having a sick child should not have to worry about their current Medicaid status due to new requirements. Citizenship status checks will impose unnecessary challenges that are not needed due to current protections already in place.

The Hawaii Primary Care Association estimates the administrative costs for our Department of Human Services will increase by $640,000 as a result of the new requirements. Mr. John McComas, the Chief Executive Officer, AlohaCare, stated, "We anticipate that there will be significant administrative costs added to our already overburdened Medicaid programs. These provisions are absolutely unnecessary and place an undue burden on the Medicaid beneficiary, to our entire Medicaid program, and ultimately to our entire state."

I know that the authors of this provision in the House believe that illegal immigrants are costing their state significant amounts of money. They claim that "more than $88 million of the state's total $7.6 billion Medicaid budget has gone to illegal immigrants. Other sources find the amount may exceed $300 million..." If Medicaid fraud in Georgia is so rampant, perhaps it would be more responsible to first investigate the problems experienced by Georgia's Medicaid program. Mandating these requirements nationwide because of the difficulties confronting one state is a prescription for disaster. The proponents of this misguided policy believe that applicants will be able to just show a driver's license or state identification card under the REAL ID Act. However, it is not expected that the Department of Homeland Security will even issue regulations until this summer and compliance is not expected until 2008.

The real purpose of the additional documentation requirements is to reduce the number of people on Medicaid in a short-sighted attempt to save money. All we have done is make it more difficult for citizens to get Medicaid rather than undocumented immigrants. Denying access to Medicaid unfairly will cost more money than it will save. Denying access to primary care will increase uncompensated care provided by our health care providers. Denying access to primary care will result in more pain and suffering of individuals. For example, people without Medicaid will have to seek treatment for renal failure instead of having access to the care needed to properly manage their diabetes.

I thank all of our witnesses today and look forward to their testimony. Thank you Mr. Chairman.