Citizenship Requirements Put Infants' Access to Medicaid in Danger

From the New York Times:

November 3, 2006
Medicaid Wants Citizenship Proof For Infant Care
By ROBERT PEAR
Under a new federal policy, children born in the United States to illegal immigrants with low incomes will no longer be automatically entitled to health insurance through Medicaid, Bush administration officials said Thursday.
Doctors and hospitals said the policy change would make it more difficult for such infants, who are United States citizens, to obtain health care needed in the first year of life.
Illegal immigrants are generally barred from Medicaid but can get coverage for treatment of emergency medical conditions, including labor and delivery.
In the past, once a woman received emergency care under Medicaid for the birth of a baby, the child was deemed eligible for coverage as well, and states had to cover the children for one year from the date of birth.
Under the new policy, an application must be filed for the child, and the parents must provide documents to prove the child's citizenship.
The documentation requirements took effect in July, but some states have been slow to enforce them, and many doctors are only now becoming aware of the effects on newborns.
Obtaining a birth certificate can take weeks in some states, doctors said. Moreover, they said, illegal immigrant parents may be reluctant to go to a state welfare office to file applications because they fear contact with government agencies that could report their presence to immigration authorities.
Administration officials said the change was necessary under their reading of a new law, the Deficit Reduction Act, signed by President Bush in February. The law did not mention newborns, but generally tightened documentation requirements because some lawmakers were concerned that immigrants were fraudulently claiming United States citizenship to get Medicaid.
Marilyn E. Wilson, a spokeswoman for the Tennessee Medicaid program, said: ''The federal government told us we have no latitude. All states must change their policies and practices. We will not be able to cover any services for the newborn until a Medicaid application is filed. That could be days, weeks or months after the child is born.''
About four million babies are born in the United States each year, and Medicaid pays for more than one-third of all births. The number involving illegal immigrant parents is unknown but is likely to be in the tens of thousands, health experts said.
Doctors and hospitals denounced the policy change and denied that it was required by the new law. Dr. Jay E. Berkelhamer, president of the American Academy of Pediatrics, said the policy ''punishes babies who, according to the Constitution, are citizens because they were born here.''
Dr. Martin C. Michaels, a pediatrician in Dalton, Ga., said that continuous coverage in the first year of life was important because ''newborns need care right from the start.''
''Some Americans may want to grant amnesty to undocumented immigrants, and others may want to send them home,'' Dr. Michaels said. ''But the children who are born here had no say in that debate.''
Under a 1984 law, infants born to pregnant women on Medicaid are in most cases deemed eligible for Medicaid for one year.
In an interview on Thursday, Leslie V. Norwalk, acting administrator of the Centers for Medicare and Medicaid Services, said the new policy ''reflects what the new law says in terms of eligibility.''
''When emergency Medicaid pays for a birth,'' Ms. Norwalk said, ''the child is not automatically deemed eligible. But the child could apply and could qualify for Medicaid because of the family's poverty status. If anyone knows about a child being denied care, we want to know about it. Please step up and tell us.''
Under federal law, hospitals generally have to examine and treat patients who need emergency care, regardless of their ability to pay. So the new policy is most likely to affect access to other types of care, including preventive services and treatment for infections and chronic conditions, doctors said.
Representative Charlie Norwood, Republican of Georgia, was a principal architect of the new law.
''Charlie's intent was that every person receiving Medicaid needs to provide documentation,'' said John E. Stone, a spokesman for Mr. Norwood, who is a dentist and has been active on health care issues. ''With newborns, there should be no problem. All you have to do is provide a birth certificate or hospital records verifying birth.''
But Dr. Berkelhamer disagreed. Even when the children are eligible for Medicaid, he said, illegal immigrants may be afraid to apply because of ''the threat of deportation.''
The new policy ''will cost the health care system more in the long run,'' Dr. Berkelhamer added, because children of illegal immigrants may go without immunizations, preventive care and treatments needed in the first year of life.
Doctors, children's hospitals and advocacy groups have been urging states to preserve the old policy on Medicaid eligibility for children born to illegal immigrants.
Sara Rosenbaum, a professor of health law at George Washington University, said: ''The new policy reflects a tortured reading of the new law and is contrary to the language of the 1984 statute, which Congress did not change. The whole purpose of the earlier law, passed with bipartisan support, was to make sure that a baby would not have a single day's break in coverage from the date of birth through the first year of life.''
California has objected to the new policy. S. Kimberly Belshé, secretary of the California Health and Human Services Agency, said: ''By virtue of being born in the United States, a child is a U.S. citizen. What more proof does the federal government need?''

--JB

Kidnappings Return to Sri Lanka

From the New York Times:


November 7, 2006
Kidnappings Haunt Long War in Sri Lanka
By SOMINI SENGUPTA
COLOMBO, Sri Lanka — Like a returning ghost, a rash of mysterious abductions has come to haunt this country once more.
Men and women are being grabbed from their homes, sometimes after dark, sometimes in broad daylight. Ransom is demanded in some cases; in others, political intimidation seems to be the point. A few have been freed, but corpses have also turned up. With rare exceptions, the crimes remain unsolved.
The abductions are a terrifying sideshow in Sri Lanka’s newly revived ethnic conflict, and they contain eerie echoes of the horrors of a generation ago, when this island nation achieved notoriety for tens of thousands of disappearances.
For nearly a quarter of a century, the ethnic Sinhalese-dominated government has been locked in battle with Tamil separatist guerrillas. A new menace has come in the form of a breakaway Tamil rebel faction, widely accused of being allied with the government and — say kidnapping victims lucky enough to tell their tales — of having a hand in the abductions.
The government denies having any link to the group, called the Karuna faction, and describes the latest abductions as a law-and-order problem that it can tackle.
It is difficult to know who is responsible, or exactly how many people have been seized.
The International Committee of the Red Cross says it received more than 350 reports of disappeared persons through late October. The National Human Rights Commission logged 419 such complaints between last December and September.
A private human rights advocacy group, called Home for Human Rights, has documented 203 cases of missing persons in the first nine months of this year, using newspaper clippings and other reports. It lists 965 more extrajudicial killings, some of whose victims might also have been abducted.
The victims come from all walks of life: a radio reporter, a university dean, a fish trader. For the most part, they are Tamil, the country’s main ethnic minority. Many of the abductions have been carried out in government-controlled territory — sometimes in the heart of this highly fortified capital, at other times in the north and east, close to military installations. Some of those kidnapped have won release only after their families appealed to the highest echelons of the state.
A white van appears repeatedly in their recollections: it is the iconic symbol of the late 1980’s, when white vans were used in a wave of abductions as the government fought a violent leftist insurrection.
Despite the official denials, the abductions have spread a cloud over the administration of President Mahinda Rajapakse, including a recommendation by the United Nations high commissioner for human rights, Louise Arbour, to dispatch foreign monitors to investigate rights abuses here.
[Instead, on Nov. 6, Mr. Rajapakse’s government announced formation of a government commission of inquiry, to be aided by foreign observers. Ms. Arbour’s office cautiously welcomed the plan but warned of the need to “establish not only individual responsibility for crimes, but the broader patterns and context in which they occur.”]
The spike in rights abuses corresponds to the swift deterioration of a 2002 cease-fire between the Sri Lankan military and the ethnic rebels, the Liberation Tigers of Tamil Eelam.
The rights record of the Tamil Tigers has hardly been exemplary. They have been repeatedly accused of abductions, including of children whom they draft into military service. The rebels are also implicated in a rash of assassinations, in particular attacks on ethnic Tamils who work with the state.
The terror of this war has grown ever sharper with the emergence of the Karuna faction, which broke away from the Tamil Tigers.
Sathasivam Kumararatnam, the fish trader, was packed into a white van on a Thursday morning in late September from a street corner near his house. His captors, he said, pistol-whipped him, blindfolded and gagged him, bound his wrists and took his cash.
He was beaten and interrogated about his links to the Tamil Tigers. His family was then pressed for nearly $10,000 for his release. The Kumararatnams bargained his captors down to half that amount, and when a courier came to pick up the ransom, Mr. Kumararatnam’s first-born son, Ravindran, beat him to a pulp. He also forced a confession out of him. “I’m with the Karuna faction,” Ravindran said he heard him say.
The police confirmed that a man arrested in connection with Mr. Kumararatnam’s kidnapping had confessed to links to the rebel faction. They gave no further details.
His captors have since released Mr. Kumararatnam. But he is not yet free. He still receives threatening phone calls, he says. “This time, we will kill you,” the callers tell him.
The political nature of many of the abductions, even in cases where the kidnappers’ identities are hard to pin down, seems clear.
Nadaraja Kuruparan, a Tamil radio reporter, said he was not asked for a single rupee after he was yanked from his car one early morning in August. He was held overnight at what appeared to be a private house, he said, and told he would have to “clarify” some of his reports. He was released on the outskirts of Colombo the following day, and given taxi money to return home.
The government had previously warned the station about Mr. Kuruparan’s popular talk show, on which he had interviewed a Tamil Tiger leader this year. Since his kidnapping, he has decided to take the talk show off the air.
In another case, Balasingam Sugumar, the dean of arts at the main public university in Batticaloa, in the east, was plucked from his house and detained for 10 days, despite his family’s quiet efforts to buy off his captors, the family said.
In exchange for his release, his abductors demanded the resignation of a senior university administrator, whom they accused of having links to the Tamil Tiger rebels. It remains a mystery how the white van that came to get him on a Saturday night in late September managed to pass through the military checkpoints that sit on both ends of his road.
His family says they do not know what ultimately led to Mr. Sugumar’s release, only that they reached out to representatives of each of the warring parties, including President Rajapakse, who promised to investigate.
Mr. Sugumar refused to be interviewed. [He has since fled the country, his family said.]
For now, there seems to be little consensus within the government on who is behind the abductions, let alone what to do about them.
A senior negotiator for the government, Palitha T. B. Kohona, said the kidnappings represented a law-and-order challenge for the state. “We would like to get to the bottom of this,” he said. “We will intensify investigations if necessary.”
Gotabaya Rajapakse, the president’s brother, who also serves as defense secretary, said in late October that “lots of people” had been apprehended in connection with the abductions. But he did not have details on how many and in what period.
His claim was contradicted by a retired judge whom the president appointed to look into the abductions. The judge, Mahanama Tilakaratne, said the police had made virtually no arrests. He also said he believed many of the recent abductions were a result of personal grudges and had little to do with the ethnic conflict.
By way of example, he took out the file of one victim and pointed out that he was suspected of an extramarital affair. The judge said he could not share details of any other cases.
Many of those who disappeared a generation ago are still unaccounted for. Their faces stare out from a simple memorial erected on the outskirts of Colombo. Once a year, their families come to lay flowers.
In late October came a weeping father, W. A. W. Weerasinghe, to remember his son, Krishantha, who was stuffed into a white van one afternoon more than 16 years ago and has not been heard from since.
Along with dozens of other parents, Mr. Weerasinghe, 68, laid flowers and wept. “Disappearance is a crime against humanity,” reads a tablet at the base of the memorial. “Let us not allow it to happen again.”
At the time of those disappearances, President Rajapakse was an opposition lawmaker and a human rights activist whose colleagues were among the thousands abducted and killed. Nine months after Mr. Weerasinghe’s son disappeared, Mr. Rajapakse headed to Geneva to draw the attention of the United Nations to human rights abuses in his country, carrying with him reams of files on missing persons.
According to human rights groups and news reports from that time, the Sri Lankan police seized the documents at the airport.
Shimali Senanayake contributed reporting.

--JB