Only Crazy Horse Need Apply

Cracks Found in Medicaid Verification

By KEVIN FREKING
ASSOCIATED PRESS

WASHINGTON (AP) -
A majority of states don't verify claims of U.S. citizenship by those seeking Medicaid, which creates the potential for illegal immigrants to access the health care program, an inspector general's report has found.

"The quality assurance checks aren't there. That's how we see it," said Jodi Nudelman, an acting regional inspector general for the Department of Health and Human Services. "And it's our sense the people may not be aware of that."

Federal law says that, with a few exceptions, a person must be a citizen to receive Medicaid benefits. States can accept a signed declaration as proof of U.S. citizenship. Forty-six states do.

Only Montana, New York, New Hampshire and Texas require applicants to submit documents verifying citizenship.

Of the states that allow self-declaration of citizenship before accessing Medicaid, 27 did not conduct subsequent auditing that would verify an applicant's statements were true.

One reason the federal government allows for self-declaration of citizenship with Medicaid is that it speeds access to health care.

The inspector general's report does not address to what extent there is a problem with illegal immigrants accessing Medicaid, only that the potential exists. Only one state, Oregon, has conducted an audit to determine how often "noncitizens" gained access to Medicaid.

Oregon's secretary of state reviewed a sample of 812 applications in 2002 and found that 25 were not citizens. The state estimated that it would cost an additional $2 million if 1 percent of the Medicaid rolls are not citizens.

The Centers for Medicare and Medicaid Services responded that it agreed that states should have systems in place to ensure the citizenship of applicants. However, it also noted that the IG's report raises only a potential problem.

"The report does not find particular problems regarding false allegations of citizenship, nor are we aware of any," CMS officials replied.

In some cases, newly arrived legal immigrants, as well as illegal immigrants, can lawfully access Medicaid, but such coverage is greatly limited to emergency care.

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According to the Ohio Administrative Code: 5101:1-38-02 Section A, 3d: Self-declaration of citizenship is acceptable verification unless the information is confusing or contradictory to other information available to the administrative agency. Citizenship must be verified if the individual states that he or she is an alien or the administrative agency has reason to believe that the individual was born outside of the United States or territories.

So that means that Ohio is one of those pesky states that doesn't do the "quality assurance checks" mentioned above to make sure that those darn immigrants aren't coming here to scam the system. so. Let me ask you: how do you decide whether you are going to question a person's citizenship status or not? I guess you could take on the onerous work of verifying every applicant's citizenship status, but how realistic is that in an already heavily overburdened highly bureaucratic system that the whole country is saying is eating up too much money as is? So going on a case by case basis might make more sense. Or would it?

In Ohio, in order to apply for and receive Medicaid, no face to face or phone interview is required. You fill out your application and mail it in. According to the OAC, the only time a caseworker should NOT accept self declaration of immigration status, is if they have contradictory evidence, or reason to believe that the applicant is lying. So what would that reason to believe look like? I mean, you have no contact with the client outside of the mailed in application. How do you decide that something is fishy? Well, we have some case workers here in Franklin County who have taken it upon themselves to define "reason to believe" as: having a foreign sounding last name. That's right. If you mail in an application for Medicaid, and you get this case worker (or her manager), and you have a "foreign sounding" last name your citizenship status will be questioned, and verification will be required. Anyone who has ever applied for benefits through the government knows that it takes forever and a day to get approval, and any extra verification requirements only adds to that approval time, and the wait for you to get health care.

So going back to the last name thing. What does foreign mean? Like: anyone who isn't named Little Bear, or Yellowknife or something? I mean come on!!! Who among us, save our Native brothers and sisters, doesn't have a last name that is foreign in origin? Of course, someone named Jones, or McCain, or Edwards would never be questioned. But people with those names are just as likely to be non-citizens as I am. The advocate (who is a U.S. citizen of Irish heritage: blonde hair, blue eyes, pure Ohioan), married a Latino man, and shares his last name. When speaking a caseworker over the phone the advocate asked her if SHE applied for Medicaid, would they make her prove she was a citizen, because of her last name? The caseworker told her yes, she would. In other words: if they have reason to believe that you have Latino, or African, or Asian ancestry, then you are suspect, and you will have to wait even longer to get the healthcare that you are eligible for. In other words: their bias = your loss.

Of course this doesn't even begin to address that fact that immigrant women who are pregnant and who will give birth to U.S. citizens are NOT entitled to prenatal care through Medicaid. That's really smart! That baby's (often expensive) health problems that may result from not receiving care in the womb WILL be paid for through Medicaid (your tax dollars and mine), but any kind of prevention against those health problems aren't. That's fiscally reeeealllly smart, no? Why aren't pro-lifers up in arms about the fact that we don't have universal prenatal care, or universal health care for all kids? But that's a rant for another day.