Enroll'em First, Verify'em Later

With Obama's health law continuing to be put into effect, new regulations have been rolled out that relate to enrolling people in Medicaid, the Children's Health Insurance Program (CHIP), and for premium subsidies through the exchanges. The regulations squarely address aspects of verification of immigration status. Bottom line, it directs states and others to take someone's word for it that he or she is "lawfully present".

Some of the "fine print" for Medicaid, the welfare program for low-income health care, pushes presumed eligibility even further into a dubious "honor system". The regulations take people's word, whether or not they can produce documents (e.g., a Social Security number), and sign them up "promptly" for Medicaid and similar health care.

For instance, one part of the proposed rule reads:

Thus, if the agency cannot resolve inconsistencies in a data match with SSA or DHS (performed either in accordance with §435.949 of the final Medicaid eligibility final rule or proposed §435.956(a)(1) or (2)) in a prompt manner, such that eligibility would be determined and benefits provided with the same promptness as if the agency were able to verify citizenship or immigration status in real-time, the agency must begin the reasonable opportunity period, and benefits must be furnished as soon as other eligibility criteria are verified, in the same manner and as promptly as such criteria are verified for applicants generally. In the case of an individual with respect to whom a temporary immigration status was verified at application and with respect to whom the agency is re-verifying satisfactory status, regulations at §435.911(c) in the Medicaid eligibility final rule similarly require that benefits be furnished during the reasonable opportunity period afforded under §435.956(g). [p. 82]

In other words, welfare benefits must begin for the unverified alien or U.S. citizen as soon as things like income level show that the person would qualify. Benefits must continue through the "reasonable opportunity period" for contesting denial. This kind of intentional loophole could prove expensive. It will certainly contribute to higher health care spending through Medicaid (an entitlement program already stressing our ability to pay for it).

Remember Ronald Reagan's quote to Mr. Gorbachev: "Trust but verify"? That would be good advice here. It will be much more difficult to remove unqualified aliens from Medicaid once they're in the program. Verification should be completed before those whose immigration or citizenship status remains in question start collecting any benefits. Or, at least, they should be apprised that if the status check finds they aren't "lawfully present", they must repay Uncle Sam for the cost of any medical benefits they collect while in this presumptive eligibility loophole.