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memorandum in opposition

Empire Justice Center Memo in Opposition: Don’t Require Unproven and Duplicative Biometric ID Program for Medicaid

A.6555-D (Rivera) / S.4384-D (Ranzenhofer)

This bill, if enacted, would require the Department of Health to implement a program requiring the use of biometric technology by clinics, pharmacies and hospitals participating in New York’s Medicaid program to identify Medicaid recipients at the point of being seen by clinical staff and again upon completion of care or services.  The Department would be required to issue requests for proposals for the program (RFP) by January 15, 2013.  The successful bidder would propose a program capable of storing the biometric markers and logs of all billed services; the program must be revenue neutral from inception.

While on its face the intent of this legislation is laudable, we believe that this bill will cause undue harm to individuals attempting to access health services and will only serve to add another administrative burden to an already overburdened system. 

In New York, because of the recent and dramatic expansion of Medicaid Managed Care, any program for using biological data to counter fraud would have to be layered on top of the care management and fraud protections already in use by the managed care plans.  Almost all recipients will be mandated into managed care, and pharmacy services will be included in the managed care package, as well as clinic and hospital services.  The only Medicaid population that will remain in fee for service Medicaid after the expansion is implemented are those “dually eligible” for both Medicaid and Medicare – and even this population is going to be moved into managed care by 2015.  To add an additional fraud protection program on top of New York’s Medicaid managed care fraud program will create an enormous administrative complication for very little added benefit, given the care management and fraud protections plans already put in place.

Furthermore, the Center for Medicare and Medicaid Services (CMS) will not provide federal funding for technologies associated with biometric screening.  Without CMS support, it is difficult to imagine how the cost of such a program could ever be cost natural as the bill requires.  Despite this unproven cost neutrality claim, the Department of Health would nonetheless be mandated to invest the time and staff resources to develop the request for proposals for the biometric contact and would have to evaluate resulting submissions.  Given all of the other changes and implementation challenges currently facing the Department of Health, we believe it would be irresponsible to use precious resources in this manner. 

Studies of the use of biometric requirements (finger imaging) in the Food Stamp Program have repeatedly shown that biometric requirements regularly and inappropriately deter eligible households from participating. [1]  This is especially true with respect to elderly and disabled individuals; families living in rural areas of the state, many without reliable access to transportation; families with working adults who cannot take time off from work; and households with children between the ages of 18 and 21, whose cooperation with the finger imaging requirement is sometimes impossible for the parents to obtain.

Finger imaging technologies are not failsafe and produce errors.  Empire Justice Center’s December 2011 analysis of New York City’s Food Stamp finger imaging program found that 97% of households whose Food Stamp applications were denied due to failure to comply with finger imaging successfully challenged their denials at the fair hearing level, due to rampant mistakes in the finger imaging process.[2]  Such errors can mean that applicants guilty of fraud are not detected and that legitimate applicants are deemed fraudulent.  Any other biological data collection will likewise be subject to error.  Although the bill gives lip service to ensuring that recipients have access to emergency services in the event of a malfunction, it is not clear how the determination will be made that a malfunction has occurred, or that full access to services would be maintained even if agreement was reached concerning a malfunction.
   
Finally, there has been no evidence on a national or statewide level that biometrics are a cost effective and efficient method of preventing fraud.  Indeed, finger imaging systems have proved costly to states, to the degree that only two states still use the technology for fraud detection in the Food Stamp Program.  Furthermore, it is unclear that the amount of fraud deterred warrants their costs to the state itself, even without consideration of the costs to eligible households that do not apply.  It is difficult to imagine how gathering other biological data such as DNA or palm patterns could prove any more effective.  

Imposing onerous biometric eligibility requirements on New York’s Medicaid population (including 2 million children, half a million elderly recipients and over 600,000 disabled individuals) and the providers who serve them – on top of already existing fraud detection processes- is a well-intentioned but misguided proposal and should not be enacted into law.  

End Notes:
 [1] See Access and Access Barriers to Getting Food Stamps: A Review of the Literature, Food Research and Action Center, February 2008, pp. 68-69, available at http://www.frac.org/pdf/FSPaccess.pdf
 [2] See “Time to Leave Fingerprints Behind,” Empire Justice Center, December 2011, available at http://www.empirejustice.org/publications/reports/new/time-to-leave-finger-prints.html

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05/01/12

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