Care costs for undocumented immigrants stack up

Facing ever-increasing financial losses, Miami-Dade's struggling Jackson Health System has spent $33 million this year alone on caring for undocumented immigrants.

BY JOHN DORSCHNERjdorschner@MiamiHerald.com

On a quiet street in northwestern Miami, a Jackson nursing home serves 60 undocumented immigrants -- some paralyzed, quite a few on ventilators -- costing Miami-Dade taxpayers about $318 a day per patient.

``There's no way to place them anywhere else,'' says Armand Gonzalez, administrator of the Jackson Memorial Long-Term Care Center.

The cost of their care is part of the reason why the county's public hospital system is struggling with growing financial losses that border on the disastrous. Losses are expected to escalate to $168 million next year because of South Florida's unique problems -- high numbers of uninsured and high healthcare costs that keep increasing the ranks of the uninsured.

On the national level, the issue of undocumented immigrants has become politically explosive.

Some conservatives maintain that federal law, which requires everyone be treated in emergency rooms, has provided an opening for the undocumented who are flooding ERs and driving up the nation's healthcare costs. Many healthcare experts say such claims are exaggerated in most locations. ``The idea that they're imposing a big financial burden on our healthcare system has been distorted,'' says Peter Cunningham, a senior fellow at the Center for Studying Health System Change in Washington. National data show that undocumented immigrants are only a small percentage of the uninsured and that ``the problems are highly localized.''

South Florida appears to be a special case. Jackson Chief Executive Eneida Roldan says there is ``a huge void'' in present reform proposals because they do not offer solutions to pay hospitals for their immigrant care costs.MILLIONS IN COSTS

Roldan knows the numbers. Last year, undocumented immigrants visited Jackson 77,415 times, costing the system $38 million in unpaid care. So far this year, 54,858 visits have cost $33 million.

That is less than 10 percent of the $500 million the system spends on charity care each year, but more than half of the $56 million that Jackson expects to lose this fiscal year.

To varying degrees, all hospitals in the region have had to pay for undocumented immigrant care costs. Broward Health, the public system in North Broward, estimates it spent about $16 million last year treating about 12,000 foreign patients who were probably undocumented.

In Miami-Dade, some are poor laborers who never get primary care and end up in the emergency room very sick.

``Our hands in many ways are tied,'' says Jackson spokesman Robert Alonso. ``If you do the bare minimum, you are literally sentencing that patient to death. All the ethical and moral issues are there.''

Jackson has never gone to the lengths of Martin Memorial Center in Stuart, which in 2003 chartered a plane to take Luis Alberto Jimenez back to his native Guatemala. An illegal immigrant, he had cost the hospital more than $1 million after a car accident left him in a coma. The hospital acted while a relative was still battling in court to stop the deportation.

In Jackson's experience, undocumented patients can run from young children needing transplants to the elderly. Last year, 13 percent of them were over 65. Since they do not quality for Medicare, the hospital did not get reimbursed for $4.6 million of their care cost.

NURSING HOMES

For long-term cases, Jackson operates two nursing homes -- one on Northwest 22nd Avenue, about two miles from Jackson Memorial, and the other off Old Cutler Road in South Dade. About two-thirds of these patients are on Medicaid, the federal-state insurer of the poor, and most of the remaining third are undocumented immigrants.

Both facilities lose money, but at $318 a patient a day, they cost the system considerably less than caring for them in the hospital, where charges average $2,000 daily.

Altogether, the two facilities have about 95 undocumented immigrants. In all cases, the patients are there because they need continuing care. Jackson says it can't release any information about them because of privacy laws.

Most government programs do not pay for undocumented immigrants, but under Section 1011 of the Medicare Modernization Act of 2003, the federal government provided for their care $250 million a year for fiscal years 2005 through 2008. The program was extended to 2009, but there is no provision for next year.

Sandra Johnson at Jackson says Section 1011 funds are strongly stacked toward the West Coast. Only $8 million a year go to Florida, while California gets $70 million, Texas $46 million and Arizona $45 million.

To get some of that money, Jackson submitted 2,908 claims in 2008 for $23.4 million. It was reimbursed $543,621.31.

Jackson officials want Congress to resurrect the program for next year, with much fairer funding for Florida.

Outside the emergency room, Jackson's primary care clinics treat anyone who can prove they are a resident of Miami-Dade -- with an electric bill, child in the school system, or such -- but many immigration experts say those who fear deportation are unlikely to appear at a government facility for basic healthcare. Only when they get truly sick do they show up in ERs.

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