Posted on September 29, 2004

Hospitals To Reject Grant For Immigrants

Felice J. Freyer, Providence Journal, Sep. 26

Rhode Island, Miriam and Newport hospitals plan to turn away federal money that would help pay for the care of illegal immigrants — because the new grant program requires providers to document each patient’s citizen status.

“We don’t gather that information now and we don’t intend to gather it,” said Nicole Gustin, spokeswoman for Lifespan, the hospitals’ parent company. “We wouldn’t want to discourage people from seeking health care because of their immigrant status.”

Meanwhile, the Rhode Island Affiliate of the American Civil Liberties Union has called on all the hospitals in the state to forgo the money as long as it requires them to keep documentation on immigrants’ status. Steven Brown, ACLU executive director, said he had not received one response to his Sept. 13 letter to hospital administrators, but Lifespan responded to The Journal’s inquiry about it.

In Rhode Island the amount at stake is small: $381,000 a year for four years. But if any providers accept it, the strings attached could loom large for the state’s growing immigrant community.

At issue is a federal program that, starting Friday, will disburse $250 million a year to hospitals, ambulance companies and physicians around the country, but will require them to prove that the people they’ve served are here illegally.

The final guidelines detailing how that information will be gathered have not been released, but draft guidelines have stirred controversy in border states with large immigrant populations, which are expected to get most of the money.

“Hospitals are caregivers, not police officers, not border-control agents,” said David Allen, spokesman for the American Hospital Association. “We don’t want people not to come [for care] for fear of being reported or deported. If someone has tuberculosis or meningitis, we want that person to come to the hospital and receive care before he or she becomes a greater community health risk.”

Edward J. Quinlan, president of the Hospital Association of Rhode Island, said that most hospitals are waiting to see the final guidelines.

“You’ve got this delicate balance between hospitals wanting to provide care, with the belief there should be some expectation of support from the government,” he said. “It’s a very difficult public policy issue and hospitals don’t want to be placed in the middle here. . . I do not disagree with the concerns the ACLU has. We’re sensitive to them.”

“We are really struggling with this issue,” said Mary B. Kozik, vice president of Landmark Medical Center, in Woonsocket. “There is no plan right now. . . Obviously, we never turn people away. We would accept money if it’s to help people.”

Roseanne Pawelec, a spokeswoman for the U.S. Centers for Medicaid & Medicare Services (CMS), said the agency was reviewing comments about the program. (CMS is in charge of the program because it was established under the 2003 Medicare law.) Pawelec said some changes would be made. “We’re sensitive to some of the concerns that have been expressed,” she said. “Nothing’s cast in stone at this point.”

But the ACLU’s Brown said that CMS was aware of the concerns “early on” and had initially rejected alternative approaches, such as using statistical models.

Allen, of the American Hospital Association, said caregivers could use other clues, such as the lack of Social Security number, to gather the information without questioning people directly. The association proposed such alternatives in early August. The fact that final guidelines were not issued, as expected, on Sept. 1 gives hospital officials hope that CMS may change the rules, Allen said. “The general feeling is they’re at least considering what we had to say,” he said.

Draft guidelines said that if hospitals, physicians or ambulance companies want federal reimbursement for the care of undocumented immigrants, they need to obtain “acceptable evidence” of the patient’s illegal status, including invalid driver’s license or foreign passport. Providers would not automatically report their findings, but would need to keep the information available in the event of an audit.

How this effort would interact with the privacy rules in the Health Insurance Portability and Accountability Act (HIPAA) won’t be clear until the final guidelines are complete. But no matter what, any information that becomes part of someone’s medical record will remain confidential under HIPAA’s terms, said Bill Pierce, spokesman for the U.S. Department of Health and Human Services. HIPAA does allow for sharing of information among health-care providers in certain circumstances.

In his letter to hospital administrators, Brown said that patients would find questions about citizenship “traumatic” and would fear “legal consequences.”

“Some immigrants should be expected to postpone or forgo medical care because of such fears, harming both themselves and general public health,” he wrote.

Brown also wrote that the law lacked confidentiality provisions, requiring providers to share their citizen determinations with physicians and ambulance companies.

“We don’t think that any person should face fears of exposure or persecution when seeking medical attention,” Brown wrote. “We are hopeful that you will agree.”

The program is a bigger issue in states expecting the most money: Arizona, $41 million; California, $72 million; New York, $12 million; and Texas, $47 million.

In contrast, Massachusetts is slated to get $2 million and Connecticut $930,000.

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