State officials say up to 5,000 low income Iowa families are going without health care because of new federal rules that require them to show a birth certificate to qualify for the aide. As of July 1st, anyone applying for health insurance coverage through the government-paid Medicaid program had to prove they are a U.S. citizen and the most common way to do that is with a birth certificate.

The requirement, obviously, is intended to keep illegal immigrants from receiving government assistance. But Iowa Department of Human Services director Kevin Concannon says nearly all of those 5,000 Iowa families who’ve dropped out of the system are legal residents.

“We talked to our offices and they say these aren’t Latino names or what have you. These are residents…who aren’t enrolling because it’s a hassle-factor for them,” Concannon says. Concannon says for many, getting a birth certificate is just too costly.

Those living on “fairly lean” incomes might not want to spend the money to get a birth certificate, according to Concannon. He suggests they might, instead, think it’s more important to buy new tires for their car. Concannon estimates that only 100 of the 5,000 who’ve failed to remain enrolled in Medicaid were illegal immigrants. He says the rest apparently don’t have a birth certificate handy for themselves or their children.

“For low income people who move at a much higher rate than the rest of us, it’s a much bigger challenge for them to be able to produce these documents,” Concannon says. There are currently 92,000 Iowa families enrolled in Medicaid.