Eligible for Welfare Until Proven Otherwise : How hospital presumptive eligibility pours gasoline on the fire of Medicaid waste, fraud, and abuse

|

ObamaCare created a new path to waste, fraud, and abuse by expanding presumptive eligibility to a new class of able-bodied adults and forcing states to implement it. As a result, ObamaCare’s “hospital presumptive eligibility” (HPE) policy mandates that states allow hospitals—the largest recipients of Medicaid funding—to determine if individuals are eligible for Medicaid on the basis of self-reported income.

The process for enrolling an individual into temporary Medicaid coverage does not include any verification, or even the full slate of information that must typically be reported to receive Medicaid. In fact, hospitals do not even need to use a paper application—they can simply ask individuals their income and enroll them based on their verbal response. Enrolling able-bodied adults into Medicaid based on self-reported information opened a brand-new door for welfare fraud.

Due to these changes mandated by ObamaCare, hospitals can now presume able-bodied adults eligible for the program based on their word alone, which qualifies them for up to two months of taxpayer-funded Medicaid benefits.