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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.
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.
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.
The Center on Budget and Policy Priorities, a liberal research and advocacy group, estimates that three million to five million low-income citizens on Medicaid could find their coverage at risk because they do not have birth certificates or passports.
Representative John Lewis, Democrat of Georgia, said: "Many older Americans do not have birth certificates because their parents did not have access to hospitals, and so they were born at home. In the last century, all over the South, because of segregation and racial discrimination, many hospitals would not take minorities."