Humanitarian Health Laws Leave Door Open to Abuse

Medi-Cal’s system of qualifying illegal immigrants for benefits was designed to encourage them to seek care and to calm fears of deportation.

But the provisions inadvertently opened the door to abuse by foreign patients who are neither impoverished nor residents of California--key requirements for Medi-Cal eligibility.

The guidelines were devised to comply with federal and state laws that require Medi-Cal to pay for emergency, prenatal and obstetrical care for illegal immigrants.

The laws--enacted for humanitarian reasons and in the interest of public health--barred hospital workers from asking illegal immigrants to prove their eligibility. The rationale was that requiring identification or evidence of poverty might deter such people from seeking essential care.

Medi-Cal officials say these well-intentioned laws have effectively tied the hands of workers who are trying to protect the system against fraudulent claims. Frank Martucci, chief of Medi-Cal’s eligibility division, said workers cannot ask for evidence of “citizenship, Social Security number, alien registration, date of entry into the United States or even the name they used when they entered the country.”

Without this information, Martucci said, it is virtually impossible to verify an applicant’s claim of poverty--something done routinely with applicants who are citizens.

Asking an applicant if he or she is an illegal immigrant also is prohibited, Martucci said. Instead, the workers are instructed to ask applicants if they want “emergency only” coverage or “full scope” coverage--and the workers point out that no one can get “full scope” coverage without a Social Security number.

Thus, illegal immigrants are steered into choosing “emergency only” benefits.

This system makes it easy for non-resident foreigners such as tourists to obtain free medical care by posing as illegal immigrants residing in California. Until recently, eligibility workers had little recourse but to take them at their word.

Faced with mounting evidence of fraud, Medi-Cal officials in May began requiring all applicants to submit proof of residency, such as a payroll stub, California driver’s license or rent receipt. State officials say it is too soon to know the effect.