Los Angeles County health worker Leonardo Rincon lifts the birth certificate up to the light and expertly scrutinizes it. Do faint watermarks show up? Yes. He rubs his thumb over the official seal to see if it is raised. It is. He checks the number of digits in the document number. Perfect.
Ruth Torres, he decides, has brought in valid U.S. birth certificates for her six children, a valid U.S. passport for her husband and a valid green card for herself, a legal immigrant from Mexico. The family will continue to receive public healthcare benefits, as least for the next year.
Since July 2008, when Los Angeles County began implementing tougher federal verification rules, Rincon and his colleagues have gone back to check the documents of more than 100,000 recipients of Medi-Cal, the public healthcare program for low-income residents.
The county has received nearly $28 million in state and federal funds to cover the cost of the program and posted 81 people in 27 social service department offices to check documents, Walker said.
So far, they have not found one illegal immigrant who posed as a legal resident to get benefits, according to Deborah Walker, the county's Medi-Cal program director. Fewer than 1% of applicants between July 2008 and February 2009 lacked the proper documents, and many of those applicants eventually produced them, she said.
Among new Medi-Cal applicants, county officials have found a relative handful of cheaters under the tougher standards. In the El Monte office, for instance, supervisor Alma Young said that five to eight undocumented immigrants were discovered among about 7,000 applicants in her unit over the last year -- about 0.1% of the total.
"It's been a big effort without a whole lot of payback," Walker said of the program.
As the health insurance debate continues to rage, a key point of contention has been how to screen out illegal immigrants from access to any new public benefits. U.S. citizens and legal residents are entitled to full public health benefits; illegal immigrants are eligible only for emergency and pregnancy care.
Members of Congress have proposed a range of new verification requirements, including presentation of photo identification and checks with the U.S. Department of Homeland Security's immigration database. Sen. Charles Schumer (D-New York), has proposed requiring biometric ID cards -- using fingerprints, for instance -- to prove citizenship.
"The point of this is not to catch people, it's to deter them and potentially save tons of money," said Steven A. Camarota of the Center for Immigration Studies, a Washington-based research organization that advocates immigration restrictions. "If you don't have these systems, you might have hundreds of thousands of illegals trying to get health benefits."
Immigrant advocates disagree. They argue that stricter verification rules, such as those implemented last year in Los Angeles County, have proven costly, ineffective and ultimately harmful to U.S. citizens who may be deprived of healthcare because they lack the required documents.
The stricter rules were passed as part of the 2005 federal Deficit Reduction Act and require applicants for Medi-Cal to present documents proving citizenship or legal status. Previously, applicants only had to declare their status on affidavits.
Nationally, however, two federal studies have raised questions about the cost-effectiveness of the rules. One congressional oversight committee found that the regulations cost the federal government and six of nine states surveyed this year $16.6 million in new administrative costs but resulted in snagging only eight illegal immigrants.
A 2007 study by the Government Accountability Office found that half of 44 states surveyed said the new requirements had resulted in a decline in Medicaid recipients, but most of those affected were believed to be eligible citizens.
Jennifer Ng'andu of the National Council of La Raza said that as many as 13 million U.S. citizens do not have a driver's license, birth certificate or passport.
"We think there are adequate verification systems in place today, and the consequence of imposing more excessive ones will mean that people could be left out of healthcare reform," she said.
At the county social services department in El Monte, Rincon offered a different view. The bilingual 36-year-old Los Angeles native, whose parents legally immigrated from Mexico, figures he has checked out more than 240,000 documents under the new law since last year.
During that time, Rincon said, he has found only two suspicious citizenship documents -- one with a name handwritten over one whited out, the other with a name different from the one on the applicant's driver's license. But both ultimately checked out with U.S. immigration officials.