FEDERAL LAW REIMBURSES HOSPITALS FOR TREATING UNDOCUMENTED IMMIGRANTS: A PRIMER ON “SECTION 1011”
Volume 28, Issue 489 April 16, 2007
Anna C. Spencer
A little-known provision in a 2003 law helps hospitals pay for emergency care for undocumented immigrants. While some states have received more money than they can spend, others are coming up short.
The law is the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), which among other things reimburses hospitals, certain physicians and ambulance providers for some or all of the costs of providing emergency care to undocumented immigrants. Section 1011 of the MMA authorized $250 million per year for FYs 2005-2008 for those payments. Two-thirds of the funds are divided among all 50 states and the District of Columbia, based on their relative percentages of unauthorized immigrants.
The other third is divided among the six states with the largest number of apprehensions of unauthorized immigrants. In 2007, the largest allocations went to California, which received $68.5 million; Texas, $47 million; Arizona, $44.5 million; New York, $12 million; Illinois, $10.3 million; Florida, $8.7 million; and New Mexico, $6.7 million.
Providing care to low-income undocumented immigrants is “a serious problem, particularly for border states,” said Ernie Schmid, director of policy analysis at the Texas Hospital Association. Under EMTALA—the Emergency Medical Treatment and Active Labor Act—hospitals are obliged to medically screen any individual who comes to the ER, regardless of immigration status or ability to pay. If the patient is experiencing an emergency, the hospital must either provide treatment until the patient is stable or transfer the patient to another hospital in conformance with EMTALA.
Section 1011 is helpful, Schmid said—but the funds don’t cover the enormous needs in Texas. “Forty million dollars sounds like a lot of money but the scope of services covered under Section 1011 is very narrow,” he explained. Schmid predicts that Texas will use up its FY 2007 allotment because “hospitals are already billing at a rate that will exceed what we’ve been allocated.”
Section 1011 reimbursement begins when an individual arrives at the ER and continues until that patient is stabilized. But hospitals often keep the patient for longer than the stabilization period, and the rest of the inpatient stay is usually uncompensated, Schmid said.
To date, over 1,900 hospitals nationwide have registered with the Centers for Medicare & Medicaid Services to receive reimbursement through Section 1011, and so far “hospitals have found the program helpful,” said Raul Bruciaga, assistant director with the New Mexico Legislative Council Services.
That said, many hospitals find the reimbursement process “cumbersome,” Bruciaga added. Hospitals must document the immigration status of individuals in order to obtain reimbursement. While providers are not allowed to ask patients direct questions about their status, they may ask for documents or ask indirect questions, such as whether the patient is eligible for Medicaid or whether they have a Social Security number, to substantiate if he or she is an undocumented immigrant. Not only is documenting the citizenship of patients a sensitive issue, “in emergency situations—the time when EMTALA applies—obtaining this information can be extremely difficult,” said Bruciaga.
“We are satisfied with our allocation, and we appreciate the funds,” said Jeff Dye, president and CEO of the New Mexico Hospital Association. “But we are disappointed that we have not been able to fully utilize the funds that are available to us.” Hospitals in the Land of Enchantment have used only 30 percent to 40 percent of the Section 1011 dollars that have been available to them over the past two fiscal years. Unused state allocations are rolled over to the next fiscal year.
Dye attributes the slow take-up to the “learning curve” that hospitals must climb, which includes learning how to enroll in the program and how to submit claims. Plus, actuaries may have underestimated the number of undocumented immigrants who arrive in New Mexico these days.
A Brief Overview
Each year, roughly 275,000 undocumented immigrants enter the United States; altogether there are roughly 9.3 million unauthorized persons in the country. Illegal immigration puts strains on various aspects of society, such as social welfare programs and education.
But according to a number of studies, immigrants use relatively few health-care resources. A 2006 RAND study found that about $1.1 billion in federal, state and local government funds are spent annually on health care for undocumented immigrants aged 18 to 64. That amounts to an average $11 in taxes for each U.S. household. In contrast a total of $88 billion in government funds were spent on health care for all non-elderly adults in 2000.
“Our findings show a relatively small amount of tax money is spent on health services provided to undocumented immigrants,” said James Smith, an author of the report. “Costs will be much higher for educating the children of undocumented immigrants, so that’s where debate should center, not on these relatively small health-care costs.”
“The lower use of medical services by immigrants is driven in part by their lower rates of insurance,” added study co-author Dana Goldman. “But the largest factor appears to be due to their being generally healthier than the native-born population.”
© Copyright 2007, State Health Notes
|
