In the wake of criticism from hospitals and immigrants' rights advocates, the Bush administration has backed off a requirement that hospitals document the immigration status of patients in order to receive additional funds.
The controversial proposal was linked to $1 billion in new funding from the Medicare Modernization Act to help hospitals cope with the price of caring for illegal immigrants, a cost that hospitals say is increasingly straining their budgets.
In the spring, Rep. Dana Rohrabacher (R-Calif.) introduced legislation that would have forced hospitals to report illegal immigrants to federal authorities to receive the funds. Facing protests from providers who said they were not border control agents, the House defeated that proposal in May (May 24, p. 9). But soon after, the CMS came out with its own proposal which would have required hospitals to document the status of immigrant patients, although it would not have required them to report illegal immigrants to authorities. The proposal was intended to ensure that the funds would be spent properly. The measure drew fire from hospitals that argued the regulation could have severe health implications for immigrants and the broader population.
"There is a huge public concern within the immigrant population ... that (they) will be turned in for deportation," said Carla Luggiero, a senior associate director of the American Hospital Association. As a result, she said, immigrants would bypass seeking necessary care, which could put the general population at risk.
"It's well-known this population ... are at higher risk for communicable diseases," said Jan Emerson, a spokeswoman for the California Healthcare Association.
In an Oct. 1 letter to advocacy and hospital groups, CMS Administrator Mark McClellan acknowledged the policy's potential to damage provider-patient relationships. "As a result of these pending changes, providers will not be asked-and should not ask-about a patient's citizenship status in order to receive payment under this program," McClellan said. He declined to be interviewed for this story.
McClellan's letter also said that new regulations would be forthcoming but gave no further details except that the CMS would use methods that will not require doctors to obtain direct evidence of a patient's immigration status.
The AHA has suggested a system in which hospitals would gather information about patients that could strongly suggest they were undocumented immigrants. Such information would include whether a patient had an invalid Social Security number, a foreign passport or driver's license, Luggiero said. The information reported to the CMS would contain no identifying information about the patients.