Some Hospitals Plan To Decline New Federal Funds for Emergency Care Because of Immigration Concerns
Some California hospitals have said they are "not likely to seek" new federal funds to cover the cost of providing emergency care to uninsured patients that would be available only under the condition that hospitals ask patients about their immigration status, the Santa Rosa Press Democrat reports (Rose, Santa Rosa Press Democrat, 8/18).
CMS officials last month announced the program, which will offer U.S. hospitals $1 billion over four years to pay for the emergency care of uninsured patients, regardless of their citizenship status. The government hopes to determine the number of undocumented immigrants who receive treatment from U.S. hospitals and ambulance services. The government will distribute two-thirds of the funds among states, and states with the largest number of undocumented immigrants will receive the remainder. The government will make the first payments under the program on or after Oct. 1. Under the program, California will receive $72 million annually, the largest share of the funds.
For hospitals to receive the funds, they must ask uninsured patients whether they are U.S. citizens; lawful permanent residents; immigrants with valid, current employment authorization cards; students, tourists or business travelers with nonimmigrant visas; or foreign citizens with 72-hour border crossing cards. Federal officials said hospitals in most cases would not have to submit the patient immigration status information to the government, but they must retain the information to allow federal auditors to prevent improper or fraudulent payments (California Healthline, 8/10). The public comment period for the program, which President Bush enacted in December, ended Monday.
William Walker, director of the Contra Costa County Department of Health Services, said the program would increase the risk of communicable diseases spreading more rapidly, ultimately increasing state health care costs. "The requirement to ask this question in emergency rooms ... would create a barrier," Walker said, adding, "We would certainly welcome this infusion of federal funds for this obligation but without these conditions" (Chang, Contra Costa Times, 8/18).
David Ameen, CEO of St. Joseph Health System, said the program will create "an atmosphere of fear" and "may result in people arriving at the emergency department only when their condition is advanced, delaying early treatment and making symptoms harder to treat, [and] good outcomes more difficult and much more costly to achieve."
The California Healthcare Association, a trade group that represents hospitals, has said that the proposed funding is "inadequate," in part because state hospitals spend an estimated $500 million a year to treat undocumented immigrants, the Press Democrat reports (Santa Rosa Press Democrat, 8/18). CHA opposes the program and has suggested "allowing hospitals to determine patients' immigration status through other methods, such as inferring from the identification documents or the lack of documents people present," the Times reports.
CHA spokesperson Jan Emerson said, "We're hoping we can still influence this final decision. We have to try to find a balance and not create a disincentive for people to access care they need" (Contra Costa Times, 8/18).
Lea Rubio, a spokesperson for Kaiser Permanente, which has not taken an official position on the issue, said, "We are really just learning about this proposal, but one of Kaiser's policies is certainly not to ask about a patient's immigration [status] if you are in need of medical care. We are not about to do that" (Santa Rosa Press Democrat, 8/18).
CMS spokesperson Peter Ashkenaz said federal officials are only interested in patients' immigration status to determine whether hospitals qualify for the new funds, adding that currently some people applying for Medicaid are asked about their immigration status. "We're only using the information for payment purposes. We want to validate where the patients are coming from so we can pay the hospitals," Ashkenaz said, adding, "We want people to get the care they need regardless of [immigration] status" (Contra Costa Times, 8/18).