As the CMS grapples with how to pay hospitals for the illegal immigrants they treat, a new federal report concluded that the task is a daunting one.
Last year's Medicare reform law set aside $1 billion over five years to help compensate hospitals that treat illegal immigrants in their emergency departments. That money has yet to be distributed, and won't be until the CMS determines what data it expects hospitals
to produce to show how many immigrants they serve.
"Our point is that you have to find an approach working with hospitals so that the numbers (of illegal immigrants) they come up with are believable," said Janet Heinrich, director of healthcare and public health issues for the General Accounting Office, which published the report late last month at the request of 15 members of the House, many of them Hispanic.
The GAO's report found that federal and state funds meant to help hospitals absorb the cost of treating illegal immigrants do not cover all the costs and are not available to all hospitals that need them.
Hospitals do not routinely screen patients to determine their residency status, and industry lobbyists recently quashed a bill sponsored by Rep. Dana Rohrabacher (R-Calif.) that would have required such screenings in order for hospitals to obtain money earmarked in the Medicare law for treatment of illegal immigrants (May 24, p. 9).
In a written statement, Rohrabacher said last week that he strongly agrees with the GAO's recommendation that "HHS develop appropriate internal controls to ensure payments are made only for unreimbursed emergency services for undocumented aliens or certain other aliens."
Rohrabacher added: "How long will Congress look the other way to please their big corporate pals and racial grievance lobbies, while pouring American taxpayer monies down the drain to care for lawbreakers and terrorists?"
Hospital administrators said the task of demonstrating how many illegal immigrants they treat is not easy.
"We really are in a dilemma," said David Sakai, chief financial officer of two-hospital University of California San Diego Medical Center, which generates 25% of its business from charity-care patients, including those in the U.S. illegally. Sakai said the system does not collect immigration information and therefore has no specific figure on how many illegal immigrants it treats. However, he said, physicians and other staff members anecdotally report that many of the charity-care patients are in fact illegal immigrants.
"We would like to have the funds to help us carry the burden of uncompensated care, but it puts us in the position of having to report (undocumented aliens). We don't want to be put in the position of being the Immigration and Naturalization Service," Sakai said.
In the next month or so, the CMS plans to publish a white paper describing how it intends to carry out the Medicare provision, including the process for collecting information from hospitals, according to an agency official who would not provide further details last week. "The provision itself is a Catch-22 in that it requires hospitals to document something that's undocumented," the official said. Payments under the provision are scheduled to begin Oct. 1 with $250 million to be distributed annually from 2005 to 2008.
Without a standard way to determine which patients are legal residents and which are not, very little information is available to quantify how much hospitals spend treating illegal immigrants, the GAO report concluded.
For its study, based on survey responses from 351 hospitals in 10 states, the GAO attempted to tabulate the number of patients without Social Security numbers receiving emergency medical treatment and the effect their treatment costs have on uncompensated-care levels. Because of a lack of key data, however, the GAO was unable to arrive at a figure.
According to Heinrich, "Hospitals were simply not able to provide us with the information and could not even give us an estimate" of the immigrant populations they treat.
Roughly 7 million undocumented immigrants resided in the U.S. in 2000, according to the INS.