NEW YORK CITY: Initiates Medicaid Home Visits
In an attempt to crack down on Medicaid fraud, New York City Mayor Rudolph Giuliani (R) plans to expand a pilot program that sends investigators to the homes of Medicaid recipients, looking for evidence that recipients are "providing false information, and withholding information about income, resources or living arrangements." The New York Times reported yesterday that violations in these areas resulted in 4,480 rejection recommendations filed by Eligibility Verification Review investigators during a 20-month period between 1996 and 1998. Some of the rejections were reportedly made on scant evidence, such as inspectors who denied a woman's application for her son because they found a pair of what they claimed to be men's jeans. While city officials insist the home investigations "are a reasonable way to screen out people who lie on their Medicaid applications," health care providers and advocates charge that the investigations "raise a frightening and unnecessary new barrier to health care for many low-income children and adults." Advocates assert the policy impedes the efforts of federal and state officials trying to streamline the application process for families eligible for government-sponsored health insurance. "What the city is doing is in direct conflict with what's going on in health insurance policy and health care policy," said Suri Duitch, a health specialist at the Citizens' Committee for Children. The program's opponents contend that the city's "get-tough approach" on fraud encroaches on health care programs, "despite a Congressional decision to preserve Medicaid as a federal entitlement and to uncouple it from cash assistance." The Times reports that the pilot program "came as a surprise" to federal and state officials who have been laboring to "stem recent declines in Medicaid enrollment and to reduce the welfare stigma associated with government health care coverage."
Advocates for the poor note that the "Medicaid application process is too difficult and intimidating for many who are eligible," including illegal immigrants who can be easily intimidated by "home investigations ... reminiscent of the indignities of welfare in the 1960s, when inspectors routinely poked through recipients' medicine cabinets looking for men's toiletries." They add that efforts to deter welfare fraud "can backfire when applied to health care, in part because preventive care is often much cheaper than trips to the emergency room." However, Debra Sproles, spokesperson for the state's Human Resources Administration, said, "The program integrity initiative was established to make sure that only eligible people receive Medicaid." She continued, "People who don't need it and aren't eligible for the service, we don't want them on it." Federal health officials said New York City "appears to be alone in imposing such a requirement." Giuliani has filed with the state Department of Health to expand the program to "eight or nine" new sites (Bernstein, 9/20).