HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Monday, June 5, 2006

Medicaid and Immigration

As reported by Robert Pear in this morning's NY Times:

The Bush administration plans this week to issue strict standards requiring more than 50 million low-income people on Medicaid to prove they are United States citizens by showing passports or birth certificates and a limited number of other documents.

The new standards follow a tussle with Congress. Federal health officials had considered giving states broad discretion to accept affidavits in place of official documents. But House Republicans complained, and the administration backed off, allowing affidavits "only in rare circumstances."

The requirements, which take effect July 1, carry out a law signed by President Bush on Feb. 8 [Public Law No. 109-171, § 6037].

They vividly illustrate how concern about illegal immigration is affecting domestic social welfare policy. The purpose of the law was to conserve federal money for citizens, reducing the need for states to cut Medicaid benefits or limit eligibility.

The article repeats concerns that the new standards will be a hardship (and possible loss of benefits) "children, older Americans and poor people born at home in rural areas who never received birth certificates."  What the article does not say, however, is that hospitals will continue to be caught between a rock and a hard spot. 

Federal policy may be to deny health care benefits to undocumented immigrants, but it obviously doesn't go so far as to require (or even permit) the denial of health care services (emergency services, at any rate) to undocument immigrants. EMTALA requires Medicare-certified hospitals to provide a medically appropriate screening for patients who come to their ER's and to attempt to stabilize any emergency condition found to exist, and this requirement applies (as it should) regardless of the patient's citizenship status. Tightening up Medicaid eligibility rules may (or may not) make some kind sense as a matter of immigration policy, but as a health care policy it only makes a bad situation worse -- and not only for hospitals.  Eventually, everyone pays for unreimbursed care.  It's a tax that takes many forms, from higher charges for patients who can pay (though the days of free-wheeling cross-subsidization have been long gone) to the closing of emergency rooms by hospitals that can no longer afford their EMTALA obligation. (Last year Congress appropriated a few billion dollars to provide some relief for hospitals in states that have experienced a high incidence of illegal immigration, but it's a drop in the bucket.)   We need a sensible solution to this problem, not one that punishes immigrants (and their families) and providers.  [tm]

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