The Obama administration recently proposed new regulations to deny Medicare to illegal immigrants and remove them from Medicare rolls. The Centers for Medicare and Medicaid Services (CMS) are proposing U.S. citizenship or lawful presence in the United States as a new requirement for getting Medicare.
The move is a long time coming. Legislation passed in 1996 made illegal immigrants ineligible to receive federal benefits. But according to an audit performed by the Inspector General of the Department of Health and Human Services, more than 29,185 illegal immigrants had improperly received Medicare benefits from 2009 through 2011. A review of 133,541 claims revealed that Medicare had paid more than $91.6 million in claims on behalf of 2,575 unlawfully present individuals.
To identify people in the country illegally, Medicare relies on information from the Social Security Administration in order to deny claims. The Social Security Administration receives data from the Department of Homeland Security and other agencies but CMS doesn't always receive information relating to unlawful presence in a timely manner, according to the Inspector General.
Estimating that this new rule would save approximately $67 million over five years, CMS proposes to require Medicare Advantage and prescription drug plans to "involuntarily dis-enroll" people who are in the country illegally, something that may prove difficult for private plans to substantiate.
TSCL believes that while the proposal may be a sensible first step, it doesn't go far enough. Before individuals can enroll in Medicare Advantage or Part D plans, they must be enrolled in Medicare Part B and have a Medicare number. How illegal immigrants obtain that number, and whether they are properly enrolled in Medicare Part B, are two key questions. "To prevent ineligible people from receiving benefits, the responsibility lies with the 'gatekeeper' and that's the federal government," says TSCL's Executive Director, Shannon Benton. "The Social Security Administration and Medicare need to do more to prevent illegal immigrants from getting Medicare numbers to begin with," Benton says. "In addition, both Medicare and private health and drug plans need up-to-date and accurate verification systems in place to determine whether beneficiaries are legally present when they receive services," she adds.
What do you think? Should health and drug plans be responsible for removing illegals from Medicare rolls? Take a poll on the TSCL homepage today!
Sources: "Crackdown Proposed To Prevent Illegal Immigrants From Obtaining Medicare," Robert Pear, The New York Times, March 3, 2014. "Medicare Improperly Paid Providers Millions Of Dollars For Unlawfully Present Beneficiaries," Daniel R. Levinson, Department of Health and Human Services Office of Inspector General January 2013.