California To Receive About $71M in Federal Funding This Year To Care for Undocumented Immigrants

Hospitals in California this year will receive as much as $71 million in additional federal funding for providing care to undocumented immigrants under new regulations announced by CMS on Monday, the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 5/10).

Under a program announced by CMS officials in July 2004, the federal government will offer U.S. hospitals $1 billion over four years to cover the cost of emergency care for uninsured patients, regardless of their citizenship status.

The Bush administration had planned to require hospitals to ask patients directly about their immigration status, but the administration reconsidered amid criticism from hospitals and immigrant advocacy groups that the requirement would prompt immigrants to avoid necessary care (California Healthline, 10/5/04). The provision was included in the new Medicare law.

Under the final rules, hospitals cannot ask patients directly whether they are undocumented immigrants. However, hospital staff will be required to ask patients whether they are eligible for Medicaid, whether they have a border crossing card and whether they are foreign-born (Hedges/Ackerman, Houston Chronicle, 5/10).

Hospital staff do not have to ask the questions when patients voluntarily admit that they are undocumented immigrants. In such cases, hospitals staff can check a box and sign a form (Los Angeles Times, 5/10).

"In no circumstances are hospitals required to ask people about their citizenship status," CMS Administrator Mark McClellan said. According to the rules, "Hospital and other provider personnel may not selectively screen individuals regarding their eligibility status on the basis of race, color or national origin."

Hospitals will have to make photocopies of documents that indicate the immigrant status of patients, although in most cases they will not have to submit the documents to the federal government.

McClellan said that the federal government will not use information about undocumented immigrants obtained from hospital visits in "routine civil immigration proceedings." However, in rare cases, the federal government could use the information in criminal investigations, he said (Pear, New York Times, 5/10).

Under the program, hospitals can apply for reimbursement for emergency care provided to undocumented immigrants from the time patients arrive until they are considered stabilized, federal officials said (Houston Chronicle, 5/10).

However, hospitals must seek reimbursement from other sources, such as Medicaid and private health insurers, before they apply for reimbursement under the program (New York Times, 5/10).

The federal government has allocated $250 million for each year of the program (Houston Chronicle, 5/10). The government will distribute two-thirds of the funds among all states and the District of Columbia based on their relative estimated percentages of the total number of undocumented immigrants.

The six states with the largest number of apprehensions of undocumented immigrants for each fiscal year will receive the remainder. For FY 2005, the six states are Arizona, California, Florida, New Mexico, New York and Texas.

Under the program, California for FY 2005 will receive $70.8 million, the largest amount, followed by Texas with $46 million, Arizona with $45 million, New York with $12.5 million, Illinois with $10.3 million and Florida with $8.7 million (CQ HealthBeat, 5/9). Hospitals on Tuesday can begin to apply for reimbursement under the program (Los Angeles Times, 5/10).

Reimbursement will begin by September, with the funds divided among hospitals, physicians and ambulance drivers; hospitals will receive most of the funds (Houston Chronicle, 5/10).

Hospitals can allocate as much as 10% of reimbursement claims under the program to cases in which patients refuse to provide their place of birth (Freking, AP/Miami Herald, 5/10). According to the AP/Richmond Times-Dispatch, reimbursement "will be made on a quarterly basis and will be adjusted proportionally if the bills exceed the state's allocation."

Don May, vice president of policy for the American Hospital Association, said that the program likely will help the finances of hospitals located near the U.S. border. He added, "I don't know if it will completely change their financial picture, but for those hospitals on the border, this is going to make a difference in ensuring they are there to treat the patients, not just the undocumented ones, but all the patients living in those communities" (AP/Richmond Times-Dispatch, 5/10).

May also said that hospitals have concerns about how the federal government will process reimbursement claims under the program (Los Angeles Times, 5/10).

Jan Emerson, a spokesperson for the California Hospital Association, said that California provides $500 million in emergency care for undocumented immigrants annually, seven times the amount of the federal funds that the state will receive under the program. However, she added, "This is a highly symbolic first step. The federal government is finally acknowledging that it has a responsibility to pay for health care" provided to undocumented immigrants (New York Times, 5/10).

John Lott, a spokesperson for the Hospital Association of Southern California, said, "The big victory would have been full funding. But this is still a victory, because we have formal recognition by the federal government that they have a responsibility to care for illegal immigrants."

Lott noted that Southern California hospitals should receive about $35 million of California's $71 million because the region has "a higher proportion" of undocumented immigrants "than the rest of the state."

HASC represents hospitals in Imperial, Los Angeles, Riverside, San Bernardino, San Diego and Ventura counties. Lott said that "[a]ny one of these counties could make a legitimate claim for all the $35 million, and still need more."

John Wallace, a spokesperson for the Los Angeles County Department of Health Services, said that it is unclear how much funding the county's public health care facilities will receive, adding that any amount it receives will not cover the facilities' full cost of caring for undocumented immigrants (Los Angeles Times, 5/10).

Some hospitals also raised concern about the questions staff will have to ask in relation to the immigration status of patients.

Rachel Kagan, a spokesperson for the California Association of Public Hospitals, said, "This could mean millions of dollars to an individual hospital that needs that money. But from a policy point of view, the big picture concerns about asking about immigration status in a health care setting really remain for us" (Hendricks, San Francisco Chronicle, 5/10).

Cecilia Munoz, vice president of the National Council of La Raza, a Latino civil rights group, said that the new rules are an improvement over the original plan. However, she added that "hospitals will have to ask confusing, highly technical questions about immigration documents. That will create a perception in the Latino community that you have to show your papers in order to get emergency care. That's a misperception, but it may be enough to deter some people from seeking care" (New York Times, 5/10).

According to the Los Angeles Times, immigrant advocacy groups maintain that the federal government should use statistical formulas to determine the allocation of funds under the program, rather than require hospital staff to ask questions related to the immigration status of patients (Los Angeles Times, 5/10).

However, Ira Mehlman, a spokesperson for the Federation for American Immigration Reform, said that the new rules should require hospitals to report undocumented immigrants to the federal government, adding, "Hospitals complain about the enormous costs [undocumented immigrants] are running up, but they don't want to do anything about the problem" (San Francisco Chronicle, 5/10).

Mark Krikorian, executive director of the Center for Immigration Studies, said, "It seems to me that if the federal government has abdicated its responsibility for immigration enforcement, then it's responsible for making those jurisdictions whole" (AP/Miami Herald, 5/10).

Sen. Dianne Feinstein (D-Calif.), who supported the funding, said that the program will "help keep the doors of California's safety-net hospitals open. This funding comes at a crucial time, when nine California hospitals have closed in the past year, due in part to a spike in costs associated with care" for undocumented immigrants (San Francisco Chronicle, 5/10).

Sen. Kay Bailey Hutchison (R-Texas) said, "The funding provides relief, but it does not resolve the underlying problem -- verifying the extent of illegal immigrant care and eliminating fraud with the system" (Houston Chronicle 5/10).