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Monday, December 29, 2014
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Published: Tuesday, 7/18/2006

Squeezed again

IN ITS ongoing, high-publicity battle against illegal aliens, Congress has launched an assault against impoverished American citizens in need of health insurance.

The policy, which took effect July 1, works like this: to ensure that no illegal alien receives benefits from Medicaid, the government-sponsored health plan for the poor, all applicants will be assumed to be unqualified illegal aliens until they can prove that they aren't.

That might seem reasonable on its face; government requires proof of citizenship for passport and Social Security applicants. But Medicaid recipients are in a different category.

The July 1 rule requires new applicants and those renewing to prove they are citizens by producing documents, which in most cases will be a passport or birth certificate. This can be a problem for many served by Medicaid, including the elderly with dementia, the mentally ill, the mentally retarded, and children taken by child welfare authorities from abusive parents.

The Centers for Medicare and Medicaid Services imposed the new rule because Congress required it in last year's Deficit Reduction Act. Before the rule, 47 states permitted a signed declaration as proof of U.S. citizenship. States were permitted to demand proof from questionable applicants and 20 did some auditing afterward to ensure the accuracy of the applications.

A 2005 evaluation of the self-declaration system by the inspector general of the U.S. Department of Health and Human Services said the process was vulnerable, but found no particular evidence that it was being abused. It recommended that states more carefully check citizenship claims after benefits were awarded.

It also acknowledged that the Centers for Medicare and Medicaid Services permitted the self-declaration to speed the application process, particularly for poor people who are ill and need care.

Shortly after the rule took effect, the Centers for Medicare and Medicaid modified it to accommodate about 8 million of the 55 million affected. The Centers decided that people receiving Medicare or Social Security disability payments would not have to provide proof for Medicaid because they'd already done so for the other benefits.

The same is true, however, for about half of all foster children. Low-income foster children qualify for federal foster care subsidies, a program which also requires proof of citizenship. These children should be exempted from providing proof a second time for Medicaid as well.

But, really, the whole rule should be thrown out. If it remains in place, hospitals will be forced to eat the cost of treating people awaiting documents to prove their eligibility because hospitals are forbidden to turn away emergency cases. Many states will also end up paying the cost of medical care for foster children while caseworkers search for documents.

For the federal government to pass these costs down when there's no evidence of a problem is outrageous. States should be permitted to qualify applicants immediately and check later, evicting and back-charging any illegals they discover. Applicants should be presumed to be innocent American citizens until they are proven to be illegal aliens.



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