The District is closing a loophole that has allowed non-D.C. residents to get millions of dollars worth of free health insurance at the expense of city taxpayers.
The D.C. Healthcare Alliance is a free health care program for thousands of city residents who are ineligible for any other benefits
such as Medicaid. The city spends $189 per person per month to insure each participant.
The absence of safeguards toshield the alliance from fraud might have enabled rampant cheating in past years, outside auditor Bert
Smith & Co. reported in early 2008.
Non-D.C. residents had easy access to free care, the audit found, as there was “minimal or no documentation” required from people who claimed to be homeless.
But new rules that take effect Sept. 15 will require that all alliance applicants verify their city address by providing one of several documents, like a driver’s license or voter registration card, or by partnering with a nonprofit or proven District resident on a proof of residency form.
Verifying residency is expected to dramatically cut the alliance rolls. Total enrollment as of July was 54,239, but the District’s fiscal 2010 budget assumes only 45,960 participants.
The 8,279 fewer members equates to $18.8 million in savings. “Maintaining the integrity of the Alliance program is critical to ensuring its long-term sustainability during these tough economic times,” Julie Hudman, director of the Department of Health Care Finance, said in a statement.
Hudman’s agency has announced that, by the end of September, it will likely remove 365 people from the alliance rolls who are also receiving Medicaid benefits, and an additional 160 members who have private insurance.
The Bert Smith audit did not estimate a total number of ineligible alliance clients. But it did, for example, reveal that more than 600 people were allowed to remain in the alliance after their 65th birthday, when they should have been moved into Medicaid.
For every 450 people who scam the program each year, the District is out $1 million.
There were “not very many barriers because we were trying to get people in,” Sharon Baskerville, executive director of the D.C. Primary Care Association, said of the alliance of prior years. But in difficult economic times, she said, the time has come to crack down.
“We can’t allow other jurisdictions who are not paying for care for their people to get health care for their residents on the District’s dime,” Baskerville said.
