memorandum in opposition

Empire Justice Memo in Opposition: Don't Require Unproven & Burdensome Biometric ID Program for Medicaid

A.6555-B (Rivera) / S.4384-B (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, 2012.  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.

The bill defines biometric technology as technology that analyzes biological data, including DNA and finger imaging, as well as vascular patterns, eye retinas, hand measurements, voice patterns and facial patterns.  Collecting such information from recipients is certain to have a chilling effect on the use of Medicaid services by recipients, and potentially on provider enrollment in New York’s program as well, since the bill imposes significant requirements on providers as well as patients. 
 
Several published studies have shown that finger imaging requirements in the Food Stamp Program 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.

Furthermore, finger imaging technologies are not failsafe and sometimes produce errors.  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 malfunction has occurred or that full access to services would be maintained even if agreement was reached concerning a malfunction.
   
There has been no evidence on a national or statewide level that finger-imaging is a cost effective method of avoiding duplicate participation.  Indeed, finger imaging systems have proved costly to states, and 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. 

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.  To layer the program on top of Medicaid managed care program in New York creates a significant administrative complication for very little added benefit, given the care management and fraud protections plans already put in place. 

The Center for Medicare and Medicaid Services (CMS) will not provide federal financial participation 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, however the Department of Health is nonetheless mandated to invest the time and staff resources to develop the request for proposals and evaluate resulting submissions.  We cannot afford to use precious resources in this manner given all of the other changes and implementation challenges currently facing the Department of Health. 

For these reasons, Empire Justice Center strongly opposes the provisions of A.6555-B/S.4384-B, which would require Medicaid recipients to provide biometric proof of their identity. 

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

06/21/11