WASHINGTON (By Billy House and Susan
Carroll, Arizona Republic) May 10, 2005 - Starting today, hospitals and
doctors in Arizona and other states can charge the federal government for
the costs of providing emergency care to undocumented immigrants.Arizona hospitals could receive up to $45 million a year for the next four years, according to guidelines released Monday by the federal Centers for Medicare & Medicaid Services.
The announcement was welcomed by hospitals along Arizona's stretch of the U.S.-Mexican border, where health care administrators have long complained about being uncompensated for care provided to thousands of undocumented immigrants each year.
Administrators estimated the funding will cover up to 30 percent of the cost of care, but they were encouraged because of the federal government's recognition of the expenses shouldered largely by border hospitals.
"In the past, we got nothing, so this is great," said Greg Pivirotto, chief executive of University Medical Center in Tucson, which could receive $2 million to $3 million this year under the new guidelines. "It's clearly not the solution, but it will help because this is a national problem, not a local problem."
By law, hospitals cannot turn away patients, and they absorb the costs associated with caring for undocumented immigrants.
Jeanine L'Ecuyer, a spokeswoman for Gov. Janet Napolitano, said the funding is "a good start, but it's just a start."
"It doesn't completely cover all of the costs," she added.
Since the U.S. Border Patrol launched major crackdowns on illegal immigration in California and Texas in the 1990s, the flow of undocumented immigrants shifted to Arizona. With the majority of the 1.1 million arrests along the Southwestern border last year in Arizona, the state's taxpayers are "picking up the brunt" of costs associated with illegal immigration, ranging from hospitals to prisons, L'Ecuyer said.
The argument was bolstered Monday with the release of a Government Accountability Office report that showed Arizona got federal reimbursement for only 14 percent of its $100 million in costs in 2002 and 2003 for incarcerating undocumented immigrants accused of crimes.
Since February, Napolitano has been sending invoices to the federal government for those reimbursements. On March 24, she sent a bill for $195.6 million for the costs to Arizona's prison system for the years 2003, 2004 and part of 2005. An earlier reimbursement request was denied.
Congress, in passing the 2004 Medicare reform bill in late 2003, set aside about $1 billion over four years for the hospital emergency-care reimbursement program. The legislation covered care provided after Oct. 1, 2004, but hospital officials said that until Monday, there still was no system in place to seek compensation.
"We are pleased the government is starting to recognize the problem, but it's been a stuttering start," said Jim Dickson, chief executive of Bisbee's Copper Queen Hospital. "We were supposed to receive our first check April 1."
Gary Karr, spokesman for the Centers for Medicare & Medicaid Services said that two-thirds of the money, or $167 million a year, will be distributed nationally to hospitals and doctors based on a state's percentage of undocumented immigrants.
The remaining one-third, about $83 million a year, will be distributed to health providers only in Arizona, California, Texas, New Mexico, Florida and New York, where the largest numbers of undocumented immigrants were detained, Karr said. In this way, he said, those states will essentially "draw twice" from the funding.
In this fiscal year, which ends Sept. 30, Arizona's $45 million total will be the third-highest, behind only California, with $70.8 million, and Texas, with $46 million. Over the course of the four years for the funding, Arizona could receive up to $180 million .
Providers will apply for the funding by documenting costs and sending them in on a quarterly basis. Karr said adjustments will be made if a state's bills exceed its pre-set, pro rata share of the national total.
Sen. Jon Kyl, R-Ariz., who played a role in securing the $1 billion in the Medicare bill, said in a news release Monday that it is "enormously unfair for Arizona's hospitals to bear a hugely disproportionate burden for mandated emergency health treatment for illegal aliens, and relief is long overdue."
But he added, "Until the federal government secures the border, illegal aliens are going to continue to show up on hospital doorsteps. The objective here is, frankly, to keep our emergency rooms open in the meantime."
A study commissioned by Congress of the 24 U.S. counties bordering Mexico found that hospitals in those areas provided $190 million in uncompensated emergency medical care to undocumented immigrants during 2000. In Pima County alone, one of the hardest-hit areas, the tab exceeded $24 million.
"In the grand scheme of things, it's hugely important for our hospitals to finally receive this money," said John Rivers, president and chief executive of the Arizona Hospital and Healthcare Association.
Rivers said that in the past, health care administrators have not had solid estimates for the cost of caring for undocumented immigrants because hospitals are responsible to treat patients, not to determine their legal status. The hope is that, in about a year, the new billing system will give care providers a more accurate accounting of how much is spent nationwide on the care of undocumented immigrants, he added.
