by ROBERT PEAR

WASHINGTON, April 15 — More than 50 million Medicaid recipients will soon have to produce birth certificates, passports or other documents to prove that they are United States citizens, and everyone who applies for coverage after June 30 will have to show similar documents under a new federal law.

The requirement is meant to stop the "theft of Medicaid benefits by illegal aliens," in the words of Representative Charlie Norwood, Republican of Georgia, a principal author of the provision, which was signed into law by President Bush on Feb. 8.

In enforcing the new requirement, federal and state officials must take account of passions stirred by weeks of national debate over immigration policy. State officials worry that many blacks, American Indians and other poor people will be unable to come up with the documents needed to prove citizenship. In addition, hospital executives said they were concerned that the law could increase their costs, by reducing the number of patients with insurance.

The new requirement takes effect on July 1. The Congressional Budget Office estimates that it will save the federal government $220 million over five years and $735 million over 10 years.

Estimates of the number of people who will be affected vary widely. The budget office expects that 35,000 people will lose coverage by 2015. Most of them will be illegal immigrants, it said, but some will be citizens unable to produce the necessary documents. Some Medicaid experts put the numbers much higher, saying that millions of citizens could find their health benefits in jeopardy.

State officials are trying to figure out how to comply. Many said the requirement would result in denying benefits to some poor people who were entitled to Medicaid but could not find the necessary documents.

"This provision is misguided and will serve as a barrier to health care for otherwise eligible United States citizens," said Gov. Chris Gregoire of Washington, a Democrat.

Ms. Gregoire said the provision would cause hardship for many older African-Americans who never received birth certificates and for homeless people who did not have ready access to family records.

Hospitals and nursing homes are expressing concern. "The new requirement will result in fewer people being eligible for Medicaid or enrolling in the program, and that means more uninsured people," said Lynne P. Fagnani, senior vice president of the National Association of Public Hospitals and Health Systems. "They still need care, but are more likely to wait until their condition becomes more severe and more costly to treat."

The new requirement will come as a surprise to most Medicaid recipients. The law said federal officials should inform them "as soon as practicable" after Feb. 8. But the education campaign, to be conducted in concert with states, has yet to begin." .....

http://www.nytimes.com/2006/04/16/us/16medicaid.html?ei=5065&en=2f79a02d4edc9cb7&ex=1145764800&partner=MYWAY&pagewanted=print