Hospitals to Get Funds for ER Care

Hospitals in California are expected to receive a large portion of the money earmarked by the federal government for facilities whose finances are strained by the cost of providing emergency room care for illegal immigrants.

Hospitals can begin applying today for the funds under a four-year, $1-billion program announced Monday by the Department of Health and Human Services.

California hospitals are in line to receive more than any other state -- nearly $71 million in the first year of the program, or about 30% of the initial national allocation of $250 million. Funds are distributed based on a state’s percentage of undocumented immigrants and on the number of apprehensions of individuals in the state illegally.

“Southern California should get about half of that, $35 million, because we have a higher proportion of illegal immigrants than the rest of the state,” said John Lott, a spokesman for the Hospital Assn. of Southern California.

Emergency rooms are, by default, the medical provider for many of the estimated 8 million to 12 million undocumented immigrants living and working in the United States. Under the law, hospitals participating in federal insurance programs, such as Medicare, must provide emergency care to anyone, regardless of ability to pay.

The Los Angeles County health department estimated that in 2003 the annual bill at public hospitals for uninsured illegal immigrants reached $340 million.

The new federal program, one of many provisions of the 2003 bill that created the Medicare prescription drug benefit, will not offset the full cost to hospitals. But it marks the first time that the federal government is taking a direct responsibility to help pay.

“The big victory would been full funding,” said Lott, whose organization represents about 95% of the public and private hospitals in Los Angeles, Ventura, Santa Barbara, Riverside, San Bernardino, Imperial and San Diego counties. “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.

“Any one of these counties could make a legitimate claim for all the $35 million, and still need a lot more,” Lott said.

John Wallace, a spokesman for the Los Angeles County Department of Health Services, said he did not know how much the county’s public health facilities would get. But he agreed that whatever the amount, it wouldn’t be nearly enough to pay the cost of providing healthcare for illegal immigrants.

Doctors and nurses will not be required to directly ask immigrants for proof of legal status, officials said, easing concerns within the medical community that they could be turned in to immigration enforcers.

But hospital staff will have to document other personal information, such as whether a patient is eligible for Medicaid or carries a foreign identity card. Immigrant advocates say they fear such requirements could still deter some people from seeking care.

Asking indirect questions represents a compromise, said Mark McClellan, administrator of the federal Centers for Medicare & Medicaid Services. “We are not asking directly about citizenship,” he said. “We are asking for some information, which will help us determine payments in a less intrusive way.”

Don May, a vice president for policy at the American Hospital Assn., said he was fairly sure that “hospitals will not be turned into immigration offices” because of the program, but added that the industry still has questions about how the government will process claims for reimbursement. Some hospitals may find the paperwork burdensome, he said.

McClellan said that hospitals would have to maintain records of the information they collected on undocumented immigrants, but that no personal data would be routinely sent to Washington.

He said that the Department of Homeland Security, which is responsible for immigration enforcement, has told health officials that it will not seek access to the information to carry out deportation proceedings, which are considered civil cases.

“We have been in contact with DHS, and they do not intend to use this for any civil immigration cases,” McClellan said. “They do not think this information will be very useful.”

But immigration enforcement officers may seek hospital records in some criminal investigations -- for example, when pursuing smugglers or gang members.

“If there is a specific criminal investigation, they could potentially use this information,” McClellan said.

A federal form for use by hospital staff outlines three groups of questions to be asked in establishing whether an immigrant’s expenses can be billed to the government. None of the questions would need to be asked if the patient voluntarily admitted being in the country illegally. In that case, hospital staffers would only check a box and sign the form.

If immigration status is uncertain, the hospital must first ask whether a patient is eligible for Medicaid, the federal-state health program for low-income legal U.S. residents. Then, staffers must ask whether the patient entered the country under a program that allows a temporary stay. Finally, the hospital must look for other indicators, such as foreign identification papers or a fake Social Security number.

Immigrant advocates objected to the questions. They said the government should use statistical methods to allocate the money and avoid questions that may deter some people from going to the emergency room.

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Times staff writer Eric Malnic in Los Angeles contributed to this report.