Topeka ? Thousands of low-income and disabled Kansans have lost or been denied health care coverage since new rules took effect that require documented proof of U.S. citizenship, according to state officials.

In addition to the loss of benefits, the federal verification rule is a bureaucratic nightmare, officials said.

“The impact to the consumer has been severe,” said John Anzivino, a vice president and project manager for Maximus, the company that provides administrative services to the state for Medicaid and HealthWave.

“From our perspective, this has possibly been the most dramatic change and challenge to the Medicaid program since its inception,” Anzivino said in recent testimony to a state legislative committee.

Since this summer when the new rules took effect, the number of beneficiaries in Kansas has dropped from 271,000 to 253,000 – a reduction of 18,000 people.

Officials couldn’t provide an exact figure of how much of the reduction was attributed to the citizenship documentation requirement, but they said much of it was.

The requirement was part of last year’s federal deficit reduction law. It was seen as a way to prevent illegal immigrants from enrolling in the state’s federally funded programs that provide health care to the disabled and needy.

But consumer advocates said many vulnerable people who legitimately were eligible for assistance would lose coverage because they couldn’t produce the necessary documentation.

“We expect that many of these that have lost coverage will regain coverage once they have gathered and provided the necessary documentation,” said Marcia Nielsen, executive director of the Kansas Health Policy Authority. “They will, however, experience a gap in coverage that could prove to be significant for some.”

And, she said, the reduction in caseload caused by the requirement may result “in a shortfall in the estimation of funds necessary to run the program next year.”

Each person applying for benefits now must submit one primary document proving citizenship, such as a passport, or two secondary documents: one verifying citizenship, such as a birth certificate, and one verifying identity, such as a driver’s license or school identification card.

“As you might imagine, most of our consumers don’t have a passport,” Anzivino said. “Therefore they are left scrambling to come up with birth certificates and one of the federally accepted identification documents.”

The number of customer service calls each month to the Kansas Family Medicaid Clearinghouse has more than doubled from 23,000 to 49,000, the number of voice mails has increased tenfold and faxes have doubled, officials said.

U.S. Rep. Dennis Moore, D-Lenexa, whose district includes eastern Lawrence, said federal officials were aware of states’ problems with the new rules and probably would work on it when the new Congress takes office in January.

“I opposed the legislation that included this mandate, which is already adversely affecting thousands of Americans,” Moore said. “I am working with my colleagues to address this problem so that we are not excluding those who need our help the most.”