leia337

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I make it mandatory to check ID on patients unknown to us if they are picking up a controlled drug. This person who picked up pulled out a Mexican ID. I asked why doesn't she have a valid US ID. She says that doing so would require a SS#, which she did not have.

Then I look to see how she was going to pay and see that she has Medical. What the? $0 copay.

What do you think?

So are illegal immigrants eligible for Medicaid? I'm thinking not b/c isn't a valid SS# required? I did a PAR and it turns out she's polypharmacy and sees different MD's.
 

Sparda29

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I make it mandatory to check ID on patients unknown to us if they are picking up a controlled drug. This person who picked up pulled out a Mexican ID. I asked why doesn't she have a valid US ID. She says that doing so would require a SS#, which she did not have.

Then I look to see how she was going to pay and see that she has Medical. What the? $0 copay.

What do you think?

So are illegal immigrants eligible for Medicaid? I'm thinking not b/c isn't a valid SS# required? I did a PAR and it turns out she's polypharmacy and sees different MD's.
It's not your job to ask why they don't have valid US ID. Nor is it your job to play INS agent.
 
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It's not your job to ask why they don't have valid US ID. Nor is it your job to play INS agent.
While I sort of agree with you I would also not like to be the pharmacist who knowingly filled a prescription for a patient committing insurance fraud.
 

type b pharmD

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I don't know where you all are from, but here in NYC I know that there are probably tens of thousands of people who you probably cannot verify their legal status but they have a fully functioning Medicaid card.

Don't be the police, just fill the prescription.
^
this.

someone else is getting paid to check on peoples bureaucratic processing and ****.

probably better to spend your time making sure someone doesnt have a bad drug interaction
 

MountainPharmD

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It's not your job to ask why they don't have valid US ID. Nor is it your job to play INS agent.
You are correct it is not that Pharmacists job to be an INS agent.

The problem is it's someones job and that someone ain't doing it.
 

FarscapeGirl

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You are correct it is not that Pharmacists job to be an INS agent.

The problem is it's someones job and that someone ain't doing it.
I don't know what I'd do in this situation. Is it insurance fraud? I don't know what the laws are on this point or even if there are any. Legally, should you be reporting this to immigration or DSHS?

I do know that even if I thought that someone was here illegally and they were on Medicaid, that I would go ahead and fill an essential medication. I'd rather the state lose a little bit of money on paying for someone's medication then having that person end up in the emergency room/hospital. To me, that'd be the more ethical thing to do.
 
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Ackj

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It wasn't free I paid for it.
This. Plus there's no way it's an isolated incident, it's not that "someone" got something free, there are no doubt many cases of this. I'm really not sure who you can contact, although I do have a few patients on Medicaid that I'd also suspect.
 

PharmDstudent

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Who gives a f*ck. Oh no! Someone got some penicillin for free!!
Penicillin now... but it'll be Zyvox tablets before you know it! :smuggrin:
 

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Before you start breaking out the jump-to-conclusions mat, my state's medicaid program covers undocumented aliens with varying coverage depending on situation...essentially limited to medically necessary treatment only. I do live in a hippie tree-hugger bleeding heart state though, so your mileage may vary, but in any case I wouldn't go out calling ICE to round up a posse.

I was recently on a rotation at a chain pharmacy in an urban area with lots of immigrants, and since most undocumented people pay cash -> MUCH better profit compared to getting reimbursements. I'm not gonna say that chains are all about undocumented immigrants, but they definitely make a bundle compared to a medicaid reimbursement, and I doubt they would go out of their way to interfere with their business.

finally, the juxtaposition of a poor immigrant totally willing to pay 100+ bucks cash money for a flovent, while a similarly poor american complains about paying 3 bucks for a copay...it really puts the american dream/decline into perspective. but i digress.
 

Sparda29

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Usually the case that I see is that you have the illegal immigrant, but they have a kid born in the US. That kid is eligible for Medicaid. Usually, once they have a kid, they can sign up for a program like Family Health Plus.
 

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I would agree if it were a cash paying customer.
As opposed to credit or debit cards? It's against the merchant agreement to require ID for a purchase with a credit card. Trust me, I've reported businesses for doing it and they've been in trouble. It's not a matter of "free market I can refuse who I want", it's a matter of "the business you worked for signed a contract agreeing not to do something and they are trying to do it".

This policy is done in order to protect consumers.

http://www.mastercard.com/us/wce/PDF/MERC-Entire_Manual.pdf
http://www.mastercard.com/us/personal/en/contactus/merchantviolations.html
http://www.privacyrights.org/fs/fs15-mt.htm

edit: Those rules are also enforced by Visa and American Express, they just happen to share those policies too. I should add that this only applies to states where there is no law stating that ID is required for a new controlled Rx. But it applies to purchases in general.
 

owlegrad

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As opposed to credit or debit cards? It's against the merchant agreement to require ID for a purchase with a credit card. Trust me, I've reported businesses for doing it and they've been in trouble. It's not a matter of "free market I can refuse who I want", it's a matter of "the business you worked for signed a contract agreeing not to do something and they are trying to do it".

This policy is done in order to protect consumers.

http://www.mastercard.com/us/wce/PDF/MERC-Entire_Manual.pdf
http://www.mastercard.com/us/personal/en/contactus/merchantviolations.html
http://www.privacyrights.org/fs/fs15-mt.htm

edit: Those rules are also enforced by Visa and American Express, they just happen to share those policies too. I should add that this only applies to states where there is no law stating that ID is required for a new controlled Rx. But it applies to purchases in general.
That is nothing like what I was trying to get at. This has nothing to do with the discussion.

What I meant was, it is not our place to be the INS, but I would not submit a medicaid claim that I suspected was fraudulent. So I wouldn't care about immigration status for a cash paying (or credit, check, etc.) patient, but if they are on Medicaid and couldn't produce an ID I would be suspicious. I also did not mean that I plan to check the ID of every extra-tan medicaid patient, but if I needed their ID for some reason and they couldn't produce it, I would be hesitant about helping them commit Medicaid fraud. Was that more clear?
 

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That is nothing like what I was trying to get at. This has nothing to do with the discussion.

What I meant was, it is not our place to be the INS, but I would not submit a medicaid claim that I suspected was fraudulent. So I wouldn't care about immigration status for a cash paying (or credit, check, etc.) patient, but if they are on Medicaid and couldn't produce an ID I would be suspicious. I also did not mean that I plan to check the ID of every extra-tan medicaid patient, but if I needed their ID for some reason and they couldn't produce it, I would be hesitant about helping them commit Medicaid fraud. Was that more clear?
I don't think it's fair to assume that someone without an ID is committing Medicaid fraud. They must have at some point, produced a valid Medicaid card or the claim wouldn't go through, right? I also wouldn't assume that someone with an accent and no ID is illegal.

It's my opinion that as HCP, we should worry more about whether our patients are getting the medications they need than trying to discern their immigration status and worrying about fraud that may or may not be occuring. Absent incontrovertible evidence that fraud is happening (and "no ID" does not rise to that level of evidence IMO) we should do our job as pharmacists and let someone else worry about the immigration issues.
 

Passion4Sci

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As opposed to credit or debit cards? It's against the merchant agreement to require ID for a purchase with a credit card. Trust me, I've reported businesses for doing it and they've been in trouble. It's not a matter of "free market I can refuse who I want", it's a matter of "the business you worked for signed a contract agreeing not to do something and they are trying to do it".

This policy is done in order to protect consumers.

http://www.mastercard.com/us/wce/PDF/MERC-Entire_Manual.pdf
http://www.mastercard.com/us/personal/en/contactus/merchantviolations.html
http://www.privacyrights.org/fs/fs15-mt.htm

edit: Those rules are also enforced by Visa and American Express, they just happen to share those policies too. I should add that this only applies to states where there is no law stating that ID is required for a new controlled Rx. But it applies to purchases in general.
No, not because of any of that. He meant that it'd be OK if pt was paying cash because then pt wouldn't be (ostensibly) on the gov't teet, but rather, earned the cash.
 

rxlea

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If you guys are going to attempt to discern the immigration status of every single patient that looks illegal, don't move to AZ heh. Why prevent someone from receiving an important medication just because you are personally against illegal immigrants free loading on our system? Man, there are plenty of LEGAL citizens who do that. We are not the medicaid/care police and I can think of time better well spent doing other things...you know, like, delivering patient care or something like that :rolleyes:
 
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Why prevent someone from receiving an important medication just because you are personally against illegal immigrants free loading on our system?
Wow you just took this conversation into a whole new direction. I'm not even sure if there were any previous posts that even insinuated this.
 

owlegrad

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If you guys are going to attempt to discern the immigration status of every single patient that looks illegal, don't move to AZ heh. Why prevent someone from receiving an important medication just because you are personally against illegal immigrants free loading on our system? Man, there are plenty of LEGAL citizens who do that. We are not the medicaid/care police and I can think of time better well spent doing other things...you know, like, delivering patient care or something like that :rolleyes:
Isn't AZ the only state we have a legal duty to do so? ;):p:D
 

rxlea

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Wow you just took this conversation into a whole new direction. I'm not even sure if there were any previous posts that even insinuated this.
This thread is about illegal immigrants getting medicaid. If you don't run the claims through because you think they are illegal or ineligible, they might not be able to afford the med. Therefore, you are essentially preventing them from getting the medication they need. I don't see how that is so off topic from what has been previously posted.

EDIT: you also stated that you wouldn't fill a prescription that you knew what fraudulent. Question is, how would you know? Would you automatically assume because the patient can't provide ID?
 
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rxlea

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Isn't AZ the only state we have a legal duty to do so? ;):p:D
I am not sure how the new proposition is going to be implemented. Currently, whatever rules/laws there are, they are not strictly followed.

EDIT: The "law" that was passed is being appealed (well, sections of it are) so I am not sure what will come of it long term and I haven't been following since the election.
 
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Carboxide

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This thread is about illegal immigrants getting medicaid. If you don't run the claims through because you think they are illegal or ineligible, they might not be able to afford the med. Therefore, you are essentially preventing them from getting the medication they need. I don't see how that is so off topic from what has been previously posted.

EDIT: you also stated that you wouldn't fill a prescription that you knew what fraudulent. Question is, how would you know? Would you automatically assume because the patient can't provide ID?
I agree with you, but in this situation there is NO DOUBT that the patient is an illegal immigrant and is committing Medicaid fraud. The patient admitted she was not a citizen or legal resident. That's how you know it's fraudulent.
 

rxlea

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I agree with you, but in this situation there is NO DOUBT that the patient is an illegal immigrant and is committing Medicaid fraud. The patient admitted she was not a citizen or legal resident. That's how you know it's fraudulent.
Yes, this particular case. You are right. But, on the day to day, I don't feel like pharmacists should try to figure out who is legal and who is not.
 

Sparda29

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I agree with you, but in this situation there is NO DOUBT that the patient is an illegal immigrant and is committing Medicaid fraud. The patient admitted she was not a citizen or legal resident. That's how you know it's fraudulent.
They beat the system that Medicaid had in place, I don't give a ****, I'm filling it.
 

Pharmavixen

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If pharmacists start turning in illegals, does that mean INS agents will start filling scripts?

Pharmacists have enough on their plate in the course of their job, trying to catch dodgy scripts, without playing INS agents. And in and of itself, illegal immigration causes no harm.
 

Sparda29

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If pharmacists start turning in illegals, does that mean INS agents will start filling scripts?

Pharmacists have enough on their plate in the course of their job, trying to catch dodgy scripts, without playing INS agents. And in and of itself, illegal immigration causes no harm.
Personally, I quite like having the home landscaped for like $50/week instead of paying $300/week for a real landscaping company to do it.
 

SHC1984

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If pharmacists start turning in illegals, does that mean INS agents will start filling scripts?

Pharmacists have enough on their plate in the course of their job, trying to catch dodgy scripts, without playing INS agents. And in and of itself, illegal immigration causes no harm.
Pharmacists or anyone in general shouldn't be LOOKING for illegal immigrants to turn it, but if you were to accidently see one by chance you should turn them in. That's the same thing as if you catch someone cheating on an exam you should turn them in. Is it your responsibility to look HARD for cheaters on every exam? NO, but if you just happen to see one it is your responsibility to turn them in. Same with illegal immigrants or any other crimmals you see...it is not your responsbility to look for those people but if you were to see it you should turn them in of course. This should be common sense. LOL...

Illegal immigrants don't pay any taxes and are using tax paid resources...I prefer flat taxes, but that's another topic in itself. LOL...
 
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Why prevent someone from receiving an important medication just because you are personally against illegal immigrants free loading on our system?
Not filling a script because it is ILLEGAL does not imply that I'm doing so because I have something personally against illegal immigrants.
 

Carboxide

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Pharmacists or anyone in general shouldn't be LOOKING for illegal immigrants to turn it, but if you were to accidently see one by chance you should turn them in. That's the same thing as if you catch someone cheating on an exam you should turn them in. Is it your responsibility to look HARD for cheaters on every exam? NO, but if you just happen to see one it is your responsibility to turn them in. Same with illegal immigrants or any other crimmals you see...it is not your responsbility to look for those people but if you were to see it you should turn them in of course. This should be common sense. LOL...

Illegal immigrants don't pay any taxes and are using tax paid resources...I prefer flat taxes, but that's another topic in itself. LOL...
Totally agree.
 

Sparda29

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Pharmacists or anyone in general shouldn't be LOOKING for illegal immigrants to turn it, but if you were to accidently see one by chance you should turn them in. That's the same thing as if you catch someone cheating on an exam you should turn them in. Is it your responsibility to look HARD for cheaters on every exam? NO, but if you just happen to see one it is your responsibility to turn them in. Same with illegal immigrants or any other crimmals you see...it is not your responsbility to look for those people but if you were to see it you should turn them in of course. This should be common sense. LOL...

Illegal immigrants don't pay any taxes and are using tax paid resources...I prefer flat taxes, but that's another topic in itself. LOL...
Totally agree.
 

rxlea

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Not filling a script because it is ILLEGAL does not imply that I'm doing so because I have something personally against illegal immigrants.
Ok
 

Soonersyko

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Pharmacists or anyone in general shouldn't be LOOKING for illegal immigrants to turn it, but if you were to accidently see one by chance you should turn them in. That's the same thing as if you catch someone cheating on an exam you should turn them in. Is it your responsibility to look HARD for cheaters on every exam? NO, but if you just happen to see one it is your responsibility to turn them in. Same with illegal immigrants or any other crimmals you see...it is not your responsbility to look for those people but if you were to see it you should turn them in of course. This should be common sense. LOL...

Illegal immigrants don't pay any taxes and are using tax paid resources...I prefer flat taxes, but that's another topic in itself. LOL...
You make it sound like illegal immigrants are a type of animal in the wild. Try reading your post in a British accent and very soft as if you are talking about hunting a wildebeest.

How exactly do you spot an illegal immigrant? How exactly do you spot a cheater? I would be pissed to the point of yelling if someone reported me as being illegal even though I was legal or even if they reported me as being a cheater. You will be a pharmacist and you have no credentials when it comes to spotting an illegal immigrant.

No, not because of any of that. He meant that it'd be OK if pt was paying cash because then pt wouldn't be (ostensibly) on the gov't teet, but rather, earned the cash.
Aw man, all that typing for nothing :(
 

FarscapeGirl

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Pharmacists or anyone in general shouldn't be LOOKING for illegal immigrants to turn it, but if you were to accidently see one by chance you should turn them in. That's the same thing as if you catch someone cheating on an exam you should turn them in. Is it your responsibility to look HARD for cheaters on every exam? NO, but if you just happen to see one it is your responsibility to turn them in. Same with illegal immigrants or any other crimmals you see...it is not your responsbility to look for those people but if you were to see it you should turn them in of course. This should be common sense. LOL...

Illegal immigrants don't pay any taxes and are using tax paid resources...I prefer flat taxes, but that's another topic in itself. LOL...
Of course illegal immigrants don't pay any taxes. If you're illegal, you don't pay sales tax, and they certainly never use a fake SS and get payroll taxes deducted.

Look, I don't like that people are here illegally, but it appears that enough people want them here to do cheap labor that for now they'll still be here.
 

owlegrad

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Of course illegal immigrants don't pay any taxes. If you're illegal, you don't pay sales tax, and they certainly never use a fake SS and get payroll taxes deducted.

Look, I don't like that people are here illegally, but it appears that enough people want them here to do cheap labor that for now they'll still be here.
Nor do they pay sale tax or property tax.
 

All4MyDaughter

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Nor do they pay sales tax or property tax.
They are also exempt from tolls and charges for utilities like electricity, gas and water. You get a little card that says "I'm illegal" and just waive it at the tollbooth operator and they let you through. You send a copy of it to the utility company and they can't charge you for services. Betcha didn't know that, did you? :p
 

rxlea

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They are also exempt from tolls and charges for utilities like electricity, gas and water. You get a little card that says "I'm illegal" and just waive it at the tollbooth operator and they let you through. You send a copy of it to the utility company and they can't charge you for services. Betcha didn't know that, did you? :p
ZOMG You get free internetzzz too!!!!!!!!!
 

All4MyDaughter

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I agree with you, but in this situation there is NO DOUBT that the patient is an illegal immigrant and is committing Medicaid fraud. The patient admitted she was not a citizen or legal resident. That's how you know it's fraudulent.
Wrong.

"Not a citizen" does not equal illegal.
"Not a legal resident" does not equal illegal.
"No SSN" does not equal illegal.
"No US ID card" does not equal illegal.
"Funny accent" does not equal illegal.
"Looks foreign" does not equal illegal.
"Can't speak English" does not equal illegal.

And yes, there are circumstances where people meeting the criteria above can obtain coverage under public health care programs like Medicaid. So there is really no way a pharmacist, pharmacy student or technician can DEFINITIVELY tell if someone is "legal" or not. Unless they tell you, "I'm illegal and I got this medical card fraudulently, muhahahaha!!" you'd better not deny them care and you'd better not set the INS on them. Unless you just like getting fired and possibly sued.
 

owlegrad

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Wrong.

"Not a citizen" does not equal illegal.
"Not a legal resident" does not equal illegal.
"No SSN" does not equal illegal.
"No US ID card" does not equal illegal.
"Funny accent" does not equal illegal.
"Looks foreign" does not equal illegal.
"Can't speak English" does not equal illegal.

And yes, there are circumstances where people meeting the criteria above can obtain coverage under public health care programs like Medicaid. So there is really no way a pharmacist, pharmacy student or technician can DEFINITIVELY tell if someone is "legal" or not. Unless they tell you, "I'm illegal and I got this medical card fraudulently, muhahahaha!!" you'd better not deny them care and you'd better not set the INS on them. Unless you just like getting fired and possibly sued.
So what is a non-legal resident?
 

All4MyDaughter

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So what is a non-legal resident?
LMGTFY... :D

A legal permanent resident is someone who has a Green Card.

There are people who are here legally but are not legal permanent residents. J visas, F visas and K visas are some examples that come to mind. Some refugees (depends on circumstances). The patient I was thinking of in my previous post (no US ID, no SSN, not a citizen, not a legal resident, didn't speak English, looked foreign, had a funny accent, etc) but was LEGITIMATELY receiving benefits under our state medical assistance program was here on a F2 visa.

My point is that we don't have the skills/knowledge to know who is "legal" and who isn't and we shouldn't be playing INS agent. It's not our role.
 

Quiksilver

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They beat the system that Medicaid had in place, I don't give a ****, I'm filling it.
You should. You pay into that system. In NYS, you should especially be concerned with the growing costs associated with medicaid
 

Carboxide

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Wrong.

"Not a citizen" does not equal illegal.
"Not a legal resident" does not equal illegal.
"No SSN" does not equal illegal.
"No US ID card" does not equal illegal.
"Funny accent" does not equal illegal.
"Looks foreign" does not equal illegal.
"Can't speak English" does not equal illegal.

And yes, there are circumstances where people meeting the criteria above can obtain coverage under public health care programs like Medicaid. So there is really no way a pharmacist, pharmacy student or technician can DEFINITIVELY tell if someone is "legal" or not. Unless they tell you, "I'm illegal and I got this medical card fraudulently, muhahahaha!!" you'd better not deny them care and you'd better not set the INS on them. Unless you just like getting fired and possibly sued.
From a quick google search, it appears that you must be a LEGAL ALIEN for 5 years or more to qualify for Medicaid or Medicare. Legal aliens are all issued a SSN. Citizens are not required to have one but it is required for things like attending public school and receiving public money (e.g. Medicaid). So... no. If you do not have a SSN, you are not legally receiving government funded health care.

I will agree that the person may not be an illegal immigrant. However, they are definitively committing Medicaid fraud.
 

All4MyDaughter

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From a quick google search, it appears that you must be a LEGAL ALIEN for 5 years or more to qualify for Medicaid or Medicare. Legal aliens are all issued a SSN. Citizens are not required to have one but it is required for things like attending public school and receiving public money (e.g. Medicaid). So... no. If you do not have a SSN, you are not legally receiving government funded health care.

I will agree that the person may not be an illegal immigrant. However, they are definitively committing Medicaid fraud.
I think it's probably state by state. I can assure you that refugees qualify for Medicaid much sooner than 5 years. At least in my state, they qualify before they get a SSN or Green Card. Refugees and others (like the patient I described who was on an F2 visa) qualify for "presumptive eligible Passport" and can receive benefits. Passport is the Medicaid managed care organization in this area. I just finished a rotation at a public health clinic pharmacy and filled RXs/provided MTM services for many non-citizen, non-permanent resident patients who were on public assistance.

And yes, those who become legal residents (like refugees) do end up getting social security numbers. But people here on other types of visas often do not and there are ways that they can obtain public medical assistance, as I've described.
 

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I think it's probably state by state. I can assure you that refugees qualify for Medicaid much sooner than 5 years. At least in my state, they qualify before they get a SSN or Green Card. Refugees and others (like the patient I described who was on an F2 visa) qualify for "presumptive eligible Passport" and can receive benefits. Passport is the Medicaid managed care organization in this area. I just finished a rotation at a public health clinic pharmacy and filled RXs/provided MTM services for many non-citizen, non-permanent resident patients who were on public assistance.

And yes, those who become legal residents (like refugees) do end up getting social security numbers. But people here on other types of visas often do not and there are ways that they can obtain public medical assistance, as I've described.
Good to know. The immigrant debate is a very hot topic right now and I'm enjoying learning a little more about it. Thanks for the info!
 

All4MyDaughter

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Ivory Tower
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Pharmacist
Good to know. The immigrant debate is a very hot topic right now and I'm enjoying learning a little more about it. Thanks for the info!
Here's a link to the CMS guidelines for eligibility: http://www.cms.gov/medicaideligibility/

It has some information but also says "check with your state" in a lot of places. Medicaid is funded in part by the Federal Government but is administered by the states, so there are 51+ different sets of rules.