State to Tighten Prenatal Care Policy

Escalating Gov. Pete Wilson’s fight to cut off health benefits to illegal immigrants, the state Health and Welfare Agency announced Thursday that women applying for Medi-Cal prenatal care will be required to show proof that they are California residents.

“Women who seek prenatal care under [a special Medi-Cal] program will now need to certify they are California residents in order to receive services,” said state health and welfare Secretary Sandra R. Smoley in announcing the policy.

The policy change, based on a fresh interpretation of federal Medicaid rules, will require women applying for immediate benefits under Medi-Cal to “provide reasonable evidence” of their California residency.

Such evidence might include a paycheck, rent receipt, driver’s license or utility bill, Smoley said.

Smoley said the California Department of Health Services will send notifications of the new policy to 1,300 health care providers next week. The policy could take weeks or months to implement, according to legal experts.

Though it may sound relatively benign, the policy change is sure to prompt court challenges.

Historically, Medi-Cal has always required state residency for benefits. But qualifying can many weeks. In order to expedite health care, a special program called presumptive eligibility came into being in 1993 to provide immediate prenatal health care on the presumption that the women would qualify later.

In 1995 the program served 100,000 women at a cost to taxpayers of $25 million.

In order to become immediately eligible for prenatal services, the only thing women had to do under the old policy was show that they were pregnant and state that their incomes were below the poverty threshold for eligibility.

The problem with the new state policy, say those who provide health care benefits to low-income women, is that women who live here but do not have documents to prove they immigrated here legally will stay away from clinics because they fear deportation.

“This is a terrible policy. These women often need health care immediately, and now you are putting up another barrier,” said Dr. Carol Jennings, who runs the South-Central Family Health Center. Most of the clinic’s clients are Spanish-speaking.

“Women can have sexually transmitted diseases, high blood pressure, diabetes, any number of conditions that require immediate attention,” Jennings said. “I can see this causing major problems for the health of the women and the unborn baby.”

Smoley, in her announcement, said the state previously had believed that it could not legally ask women to prove their residency status. But she said a letter last week to Assemblyman Jan Goldsmith (R-Poway) from Bruce C. Vladek, the administrator of the U.S. Health Care Financing Administration, said states are free to ask for residency status pending the adoption of final eligibility rules by his agency.

The letter, Smoley said, gives “the state the go-ahead to not only ask about residency status when someone seeks prenatal care, but to then deny care on that basis.”

The new policy will not apply to the provision of emergency services.

The Wilson administration contends that providing prenatal health care to illegal immigrants costs California taxpayers more than $67 million a year.

The dispute over proving residency is at the heart of much of the legal debate over Proposition 187, the anti-illegal immigrant measure approved in 1994. Among other things, the initiative would have cut off medical services to those who could not prove their legal status.

Under the complex and often baffling web of federal and state laws, a person can be living in California without federal legal status but still be a lawful resident of California for the purposes of receiving Medi-Cal benefits.