Prenatal Care Policy Disputed

The Clinton administration and a San Diego assemblyman who wants to deny prenatal benefits to illegal immigrants were at odds Friday over what the legislator contends is a major change in federal policy that gives states broad new powers to restrict health services.

Assemblyman Jan Goldsmith (R-Poway) released a letter here signed by Bruce C. Vladeck, chief of the U.S. Health Care Financing Administration, that the lawmaker said opens the door for hospitals and clinics to question women on their residency status.

In the letter, Vladeck said the Clinton administration is in the process of reconsidering federal policy that prevents states from asking women questions other than basic ones about their pregnancy or income level. Pending adoption of final rules, Vladeck said states were free to require additional information from women applying for benefits, such as “where the woman lives and whether she is in the United States legally.”

Goldsmith, carrying state legislation that would include legal residency as a precondition for receiving prenatal benefits, called Vladeck’s position “a complete reversal” of a controversial federal policy that has been guiding California law.

But Vladeck, whose agency administers the federal Medicaid program, told The Times: “It is not a change in policy.”

Vladeck reiterated that the agency had proposed a rule that would have limited what a state could ask, but a final regulation has not been issued, he said. The confusion came about, Vladeck said, because Goldsmith apparently got two differing opinions from different HCFA offices.

The issue has potentially far-reaching consequences because limitations on what health care providers can ask are at the core of legal challenges to Proposition 187, the anti-illegal immigrant initiative approved by voters, and other similar efforts.

The office of Gov. Pete Wilson, who has been in the forefront of the fight to stop aid to illegal immigrants, reacted cautiously to Vladeck’s letter.

Lisa Kalustian, a spokesperson for the state Health and Welfare Agency, said the letter looks like “a change in interpretation of federal policy,” but that administration officials were uncertain how significant it was until they had more time to study it.

Times staff writer Robert Rosenblatt contributed to this story from Washington.