One of the costs of large scale immigration (both legal and illegal) is the subsidies for medical care and other social services. Employers get cheap labor and the rest of us pick up the bill. In theory applicants for Medicaid are supposed to be American citizens. How well is this requirement enforced? Not well at all in turns out. A report from the Office of Inspector General Daniel R. Levinson of the Department of Health & Human Services has found that most states make little effort to prove citizenship of Medicaid benefits applicants. (PDF format)
Forty-seven States allow self-declaration of U.S. citizenship for Medicaid; nearly all of these require evidence if statements seem questionable. Pursuant to Federal policy, States may accept a signed declaration as proof of U.S. citizenship from applicants seeking Medicaid benefits. Currently, 40 Medicaid directors report that their State allows self-declaration of citizenship. An additional seven report that self-declaration is sometimes allowed. The four remaining directors report that self-declaration is not permitted in their State. These States are Montana, New Hampshire, New York, and Texas.Forty-four of the forty-seven States that allow or sometimes allow self-declaration have “prudent person policies” which require evidence of citizenship if statements seem questionable to eligibility staff.
I bet in practice welfare office workers rarely ask for evidence of citizenship even when someone can barely speak English. The ethos of such agencies very frequently is to help the poor and down trodden.
Thirty-two of these have written prudent person policies, and the remaining 12 have unwritten, informal policies requiring documentation for questionable statements.
Twenty-seven States do not verify the accuracy of any U.S. citizenship statements as part of their posteligibility quality control activities.
In fiscal year 2003, 27 of the 47 States that allow self-declaration did not conduct quality control activities that included verification of statements of U.S. citizenship. Of the 20 States that did review statements, 9 did so for a nonrepresentative sample of the entire Medicaid population. Consequently, some groups that could pose vulnerability to Medicaid integrity were not included in the review sample.
Some States use types of evidence that are not accepted by CMS or SSA to document citizenship for Medicaid. As reported earlier, seven States sometimes allow and four States do not allow Medicaid applicants to self-declare citizenship. Of these 11 States, 4 use types of evidence to document citizenship that are not accepted by CMS or SSA. Furthermore, 13 of the 20 States that report conducting quality control to verify statements of U.S. citizenship use types of evidence that are not accepted by CMS or SSA, such as school records, family Bibles, voter registration records, and marriage licenses.
Social Security is tougher on eligibility than Medicaid.
Medicaid-related programs are more likely to verify citizenship; their verifications may be a useful resource for Medicaid. SSA states that all applicants must provide documentary evidence of U.S. citizenship in order to receive a Social Security number or qualify for Supplemental Security Income (SSI) benefits. Forty-two of fifty-one foster care directors report that staff document U.S. citizenship when determining eligibility for Title IV-E foster care maintenance payments. Twenty-seven of fifty-one TANF directors report documenting or sometimes documenting citizenship for purposes of eligibility.
In the majority of instances, we found that these Medicaid-related programs draw on evidence accepted by CMS or SSA to document statements of U.S. citizenship. These citizenship verifications may be a useful resource for Medicaid.
Oregon is the only state to have done an audit looking for non-citizen beneficiaries and they were able to establish that in their sample about 3% of the audited cases were non-citizens and therefore not eligible. Well, imagine what the rate of non-citizen usage must be in states like California which have much higher percentages of illegal aliens living in them.
Only one State reports conducting an audit looking at self-declaration of U.S. citizenship, and it found vulnerabilities
We asked States for any quality control audits or evaluations that looked at self-declaration of citizenship. Only one State director provided an audit on this topic. This audit report found vulnerabilities related to the process of self-declaration of U.S. citizenship.
Specifically, the audit, conducted in January 2002 by the Secretary of the State of Oregon, found that the State provided full Medicaid benefits to 25 beneficiaries (of the sample of 812) who were noneligible noncitizens. The audit report concludes that there are potential risks involved in allowing applicants to self-declare their U.S. citizenship on mail-in applications, which do not allow workers to verify the accuracy of statements of U.S. citizenship.
Well, no kidding. If someone doesn't even have to show up to apply then that person could make up all the fake documents they need and simply assert their citizenship. The claims processing offices are ill-equipped to do much in the way of verification.
My guess is that official estimates of the medical costs which immigrants impose on the US citizenry greatly underestimate the real costs because a big chunk of the money going to non-citizens is labelled as money going to citizens.
Tax money going to pay for medical care for illegals is just one way we pay more for their medical care. First off, illegals are now having about 10% of the babies being born in the United States. Those babies, as US citizens, are eligible for government funded medical care. So we pay that way too.
Illegal immigration is driving up the number of medically uninsured and also one in every twelve dollars spent on medical insurance premiums goes to the cost of paying for the medically uninsured. So illegal immigration and also legal immigration of low wage workers drives up the costs of medical insurance that natives pay. The illegal immigrants can not possibly pay for their own medical insurance because low wage workers can not afford to pay medical insurance premiums.
“The cost of family health insurance is rapidly approaching the gross earnings of a full-time minimum wage worker,” said Drew Altman, President and CEO of the Kaiser Family Foundation. “If these trends continue, workers and employers will find it increasingly difficult to pay for family health coverage and every year the share of Americans who have employer-sponsored health coverage will fall.”
Low wage jobs are effectively taxpayer subsidized jobs. When people advocate for large scale immigration of people with few talents effectively they are advocating for more taxpayer subsidized work.
Cheap immigrant laborers, by going to emergency rooms for medical care, by having children they can't afford to pay for, by reducing native employment, and also by driving down wages for lower income native workers, is creating a growing segment of society that lives off of government provided subsidized paid for by middle and higher income workers.
|Share |||By Randall Parker at 2005 August 04 09:40 PM Immigration Economics|