http://www.scrippsnews.com/node/9784

Utah taxpayers foot bill for some immigrant health care
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By KIRSTEN STEWART
Immigrants who enter the country illegally or overstay their visas are barred from full coverage under Medicaid, the government health plan for low-income families, seniors and people with disabilities. Enforcement tightened earlier this month when clients began having to show proof of their legal status, such as passports and birth certificates.

But under a lesser-known federal law, undocumented immigrants who meet Medicaid's poverty guidelines can get their emergency medical bills paid.

The rule is rooted in the belief that no one should be denied life-saving care. But the program is growing more expensive as health care costs mount along with the ranks of uninsured.

In Utah, spending on emergency Medicaid for the noncitizens nearly doubled in six years, from $12.6 million in 2000 to $22.9 million in 2006. It's a small share of the state's $1.4 billion Medicaid tab, but it is outpacing growth in overall spending.

Enrollment in the emergency program also continues its steady march upward as Utah's Medicaid rolls flatten out.

"It's fair to say growth is due to an increase in immigration, some legal and some illegal," said Utah's Medicaid eligibility director, Jackie Stokes.

Utah health officials say they have no way of distinguishing which of the enrolled immigrants are here legally or illegally.

But an analysis of data by The Salt Lake Tribune reveals something about them, their lifestyles and the types of care they require.

Most cluster in areas where there are jobs, in urban towns along the Wasatch Front. Salt Lake County alone accounts for 56 percent of the emergency clients.

The vast majority (93 percent) are women, most of them between 19 and 35 years of age _ their childbearing years. The men are more evenly distributed across the age spectrum, though the largest age group is 12 and younger.

Given these demographics, it's safe to assume most of Utah's emergency Medicaid money is spent on the delivery of babies and any pediatric complications that arise, said Utah's Medicaid director Michael Hales.

Emergency Medicaid covers delivery costs, but not prenatal care. It also covers life-saving treatments for people with chronic or mental illness, trauma victims and sick children.

These are "hard-working young families looking for a better life," not a group of loafers looking for handouts, said Sabrina Morales, director of Comunidades Unidas, a support group for new immigrants. "Having babies here is not a strategy (for getting citizenship). Wherever you're from _ China, Russia or Mexico _ forming a family is just a normal process. People fall in love, join in marriage and have kids."

Health care experts argue even if Medicaid didn't cover emergency care, taxpayers would still foot the bill through higher insurance premiums.

Medicaid pays to stabilize an immigrant with renal failure, but it won't keep him or her on dialysis. The same goes for keeping a trauma victim on life support.

So hospitals pick up the tab and pass the costs along to other patients and taxpayers in the form of write-offs for charity care. LDS Hospital alone wrote off $23.2 million in charity care in 2005, up from $11.2 million in 2000, according to its spokesman, Jess Gomez. That's true charity care and not bad debt or uncollected bills, said Gomez.

Morales would like to see the government expand health coverage for low-income immigrants who might avoid costly emergency room visits if they had better preventive care.

But she knows it's a tough sell. Instead, she focuses her energy on finding more "creative ways" of improving public health.

"Maybe we need financial assistance programs where women can pay little by little and be partially subsidized with Medicaid covering 25 percent," said Morales. "Here at Comunidades, we're teaching people how to navigate the health care system and avoid trips to the hospital; to stop smoking, do annual breast examinations and eat healthier."

The extent to which noncitizens use taxpayer-funded services is and will continue to be central to the nation's raging immigration debate. Very few public benefits are actually available to undocumented workers. But charges that some are illegally dipping into food stamps and welfare triggered a special legislative session this month in Colorado.

Democratic lawmakers and Colorado's Republican Gov. Bill Owens reached a deal last week. They dubbed their compromise the toughest immigration reform package in the country.

The new law requires business owners to verify the legal status of their employees. It also mandates that all applicants for public welfare programs prove their residency.

But exempt are federally protected services, such as emergency medical care, immunizations and public education.

Heather McGregor, spokeswoman for The Bell Policy Center, a Denver think tank that opposed Colorado's reforms, said she doubts the strict requirements will send immigrants scattering to neighboring Utah and other states with more friendly laws.

"Immigrants come here for jobs, not for food stamps or free medical care," said McGregor.