Federal law generally bars illegal immigrants from being covered by Medicaid.聽 But聽a little-known part of the state-federal health insurance program for the poor has long paid about $2 billion a year for emergency treatment for a group of patients who, according to hospitals, mostly comprise illegal immigrants.聽
for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies.
The funding聽鈥� which has been around since the late 1980s and is less than 1 percent of the cost of Medicaid聽鈥� underscores the political and practical challenges of refusing to cover an entire class of people. Congress approved the program after lawmakers required hospitals to screen and stabilize all emergency patients regardless of their insurance or citizenship status.
Some groups say the services encourage people to cross the border for care, while advocates for immigrants say the funding is inadequate because it doesn鈥檛 pay for prenatal care and other vital services.
鈥淲e can鈥檛 turn them away,鈥� said Joanne Aquilina, the chief financial officer of Bethesda Healthcare System in Boynton Beach, Fla., which sees many illegal immigrants because of its proximity to farms where they harvest sugarcane and other seasonal crops.
Nearly one-third of Bethesda Hospital East鈥檚 2,900 births each year are paid for by Emergency Medicaid, the category that covers mainly illegal immigrants. The category includes a small proportion of homeless people and legal immigrants who鈥檝e been in the country less than five years.
Hospitals can鈥檛 ask patients whether they鈥檙e illegal immigrants, but instead determine that after checking whether they have Social Security numbers, birth certificates or other documents.
鈥淲e gather information to qualify patients for something and through that process, if you really hit a dead end, you know they are illegal,鈥� said Steve Short, the chief financial officer at Tampa General Hospital.
A 2007 medical article in the Journal of the American Medical Association reported that 99 percent of those who used Emergency Medicaid during a four-year period in North Carolina were thought to be illegal immigrants.
The Federation for American Immigration Reform, which seeks to limit immigration, said the funding led more women to give birth in the United States, especially since they knew that children born here would be American citizens.聽 that tens of thousands of 鈥渁nchor babies鈥� are born each year to illegal immigrants who hope that giving birth to children recognized as citizens will help the women gain legal status themselves.
Anyone born in the United States is a U.S. citizen. It鈥檚 unclear how many mothers later get green cards or become citizens.
The Federation for American Immigration Reform doesn鈥檛 dispute hospitals鈥� right to be reimbursed for care they鈥檙e required to provide.
鈥淥ur focus should be that you could save this money if you prevent the illegal immigration from happening in the first place. You can鈥檛 do it after the fact,鈥� said Jack Martin, the special projects director for the organization.
Groups that advocate for immigrants say it鈥檚 foolish for Medicaid to pay only for the births and not for the prenatal care that might prevent costly and long-term complications for American children.
鈥淚t鈥檚 a lose, lose, lose,鈥� said Sonal Ambegaokar, a health policy lawyer at the National Immigration Law Center, which advocates for low-income immigrants. She said denying broad insurance coverage to legal immigrants hurt doctors and hospitals financially, prevented patients from getting needed care and increased costs for the health system.
鈥淭here is no evidence that Emergency Medicaid is the cause of migration,鈥� Ambegaokar said. 鈥淚mmigrants migrate to the U.S. for job opportunities and reunifying with family members.鈥�
Data that Kaiser Health News collected from seven states that are thought to have the highest numbers of illegal immigrants show that the funding pays for emergency services delivered to more than 100,000 people a year.
California hospitals get about half the $2 billion spent annually on Emergency Medicaid. The rest is spread mainly among a handful of states.
In 2011, for example:
- New York spent $528 million on Emergency Medicaid for nearly 30,000 people.
- Texas reported 240,000 claims costing $331 million. (One person could be responsible for multiple claims.)
- Florida spent $214 million on 31,000 patients.
- North Carolina spent $48 million on about 19,000 people.
- Arizona spent $115 million. It couldn鈥檛 break out the number of people.
- Illinois聽spent $25 million on the cost of care to nearly 2,000 people.
The federal government doesn鈥檛 require states to report how many people receive services through Emergency Medicaid payments to hospitals.
Legal immigrants who鈥檝e been in the United States less than five years聽, though states have the option of extending it to children and pregnant women.
Despite the surge in overall Medicaid spending in the past decade,聽Emergency Medicaid costs have been remarkably stable. 聽that looked at data from the 10 states with the highest expected Emergency Medicaid costs, reported $2 billion in spending. State officials say spending varies depending on immigration patterns and that during the economic slowdown, the number of illegal immigrants dropped.
The definition of emergency care and the scope of services available through the Medicaid programs vary by state. For example, in New York, Emergency Medicaid may be used to provide chemotherapy and radiation therapy to illegal immigrants. In New York, California and North Carolina, it may be used to provide outpatient dialysis to undocumented patients.
Other states have tried to narrow the definition of 鈥渆mergency鈥� to limit what鈥檚 covered. 鈥淓ach state has its own interpretation,鈥� said Jane Perkins, the legal director of the National Health Law Program, which advocates for the working poor.
Last year, for instance, Florida changed its policy to pay for emergency services for eligible undocumented immigrants only until their conditions had been 鈥渟tabilized.鈥� Previously, its policy was to pay for care that was 鈥渕edically necessary to relieve or eliminate the emergency medical condition.鈥�
Many hospitals 鈥� particularly those in the immigrant areas of Miami and Tampa 鈥� feared the change would cut millions of dollars in funding. An administrative law judge ruled in December聽 because it didn鈥檛 go through a public hearing process; the state is appealing.
Short, the chief financial officer at Tampa General Hospital, said the $10 million the hospital collected each year to treat illegal immigrants was 鈥渧ery important to us.鈥� He noted that Medicaid pays the hospital about $1,500 for each day a Medicaid patient is in the hospital.
Jackson Memorial Hospital in Miami collects about $50 million a year in Emergency Medicaid funding, according to the state Agency for Health Care Administration.