SACRAMENTO, Calif. (MCT) — The Bush administration is pressing California to ensure that poor women are legal residents or citizens before giving them free birth control, though the policy could cost the federal government hundreds of millions of dollars a year.

State officials say requiring women to present documents to get family planning services could result in more unintended pregnancies, including among undocumented immigrants who would qualify for federally funded prenatal care and whose children would be U.S. citizens if they were born here.

Also, state officials say, it would cost the federal government and the state almost double the $261 annual price of the birth control per recipient just to conduct each background check.

The difference of opinion is stalling an agreement with the federal government, known as a waiver, that would allow Medicaid funding to continue for the state’s 10-year-old family planning program. The Bush administration has been extending the current agreement on a month-to-month basis while the debate continues. It is unclear how long this arrangement will continue.

“They just basically want us to check the immigration status of each and every person,” said Stan Rosenstein, director of Medi-Cal, a $36 billion program jointly funded by the state and with federal Medicaid dollars. “That has been their position, and that’s where we are at an impasse.”

The Bush administration has also stopped paying for mammograms and some services related to sexually transmitted diseases under the California Family Planning, Access, Care and Treatment program. Gov. Arnold Schwarzenegger has proposed using about $2.5 million in state funds to cover those services, a plan that is likely to get support from the Democrat-controlled Legislature.

Representatives of the Center for Medicare and Medicaid Services in Washington, the administrative agency in charge of Medicaid, did not respond to requests for comment about the citizenship checks.

In an e-mail, CMS spokesman Jack Nelligan said the state should never have been billing the federal government for mammography and some other disease treatments.

The debate over family planning services is just one of the hurdles states have faced in implementing the 2006

Deficit Reduction Act, a federal law requiring Medicaid recipients to prove they are in the country legally by showing their birth certificates or other documents before they can get benefits. Despite the new law, the federal government does cover limited services for undocumented immigrants, including prenatal care in some states.

California is about to implement the background check requirements for the more than 6 million low-income state residents who receive comprehensive insurance coverage through Medi-Cal. Other states have reported difficulties ensuring that all qualified citizens could find the documents they need.

For the family planning services, which are limited to birth control and disease testing, California has never required people to enroll in Medi-Cal. Instead, recipients walk into a participating clinic, fill out forms saying they are uninsured and poor, and walk out with birth control.

The federal government does not pay for birth control for undocumented immigrants, so the state has been estimating the percentage of family planning recipients who are undocumented ¤ about 14 percent of the total ¤ and covers that cost with state funds.

The annual cost of the program is about $450 million and it provides services to more than 1.5 million women and some men. The state estimates it saves as much as $1.4 billion by averting unintended pregnancies and cases of sexually transmitted disease.

Kathy Kneer, president of Planned Parenthood Affiliates of California, said she worries that requiring birth certificates and Social Security numbers to get birth control will simply dissuade legal residents from seeking help to prevent unplanned pregnancies. Kneer said Planned Parenthood affiliates in states that implemented the documentation requirement for birth control already have seen a drop-off in patients.

“It’s not going to screen out non-citizens,” Kneer said. “It just puts up a barrier for citizens, and now there are going to be long-term consequences if they end up getting pregnant. It’s not common sense, and it’s not good fiscal sense.”

California officials estimate it could cost the federal government as much as an additional $290 million a year to screen and enroll birth control recipients in Medi-Cal. On top of that, the federal tab for births and infant medical care would go up at least $400 million, the state estimates.

California officials, including the governor, are continuing to lobby the Bush administration to change course. The current funding agreement expires April 30.

“The governor feels very strongly that this (program) has been very successful,” Rosenstein said. “It needs to be continued so we have services available to people who want them without major administrative barriers.”

Clea Benson

McClatchy Newspapers