New HHS Guidelines For $1 Billion Emergency Care Program Raise Concerns From Hospitals, Immigrant Advocates

[CAL/AAEM News Service]

New HHS Guidelines For $1 Billion Emergency Care Program Raise Concerns From Hospitals,
Immigrant Advocates

August 10, 2004


Hospital officials and advocates for immigrants have raised concerns about new
HHS guidelines developed in the past few weeks that will require hospitals to
ask patients about their immigration status to obtain funds offered by the
federal government to provide emergency care for uninsured patients, the New
York Times reports (Pear, New York Times, 8/10).

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 -- in compliance with the new
Medicare law. 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
(California Healthline, 7/29). 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, followed by Texas
with $48 million, Arizona with $42 million, New York with $12 million, Illinois
with $10 million and Florida with $9 million.

However, for hospitals to receive the funds, they must ask uninsured patients
whether they are U.S. citizens; lawful permanent residents; aliens with valid,
current employment authorization cards; students, tourists or business
travelers with nonimmigrant visas; or foreign citizens with 72-hour border
crossing cards. In addition, hospital employees must sign forms for patients to
certify that the immigration status information is "true and complete";
employees who knowingly submit false information could face civil and criminal
penalties. Hospital employees also must photocopy patient passports, visas,
border crossing cards or other documents that prove their immigration status
when available. 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.


Hospital Officials, Immigrant Advocates Raise Concerns
Hospital officials and advocates for immigrants have raised concerns that the
questions about immigration status could prompt undocumented immigrants not to
seek required emergency care.

"It's likely that the undocumented immigrant parents will be terrified to seek
care for their children, let alone themselves," Marcela Urrutia, an analyst at
the National Council of La Raza, said. She added, "That could lead to serious
public health problems, including the spread of communicable diseases."

Angela Hooton, an attorney for the Mexican American Legal Defense and
Educational Fund, said, "Undocumented immigrants fear that if they answer such
questions, the information might be used against them in deportation
proceedings."

In addition, the questions could confuse "an ailing, not highly educated
person," David Martin, former general counsel of Citizenship and Immigration
Services, said.

According to the Times, hospital officials also said that the program may cost
"more to comply with the new regulatory requirements than they will receive in
federal aid"; some public hospitals estimate that the payments from the program
will cover only 10% to 15% of the cost of emergency care for undocumented
immigrants. In addition, some hospital officials said that in place of the
questions, the government should allow them to make "reasonable inferences"
about patient immigration status, and others said that the government should
use a mathematical formula to "estimate the costs that qualify for
reimbursement without having to collect the immigration information needed to
submit a separate claim for each patient," the Times reports (New York Times,
8/10). 


Source: California Healthline (www.californiahealthline.org) 


=====
Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service 
UC-Irvine


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