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Illegal immigrant funds a hospital balancing act
Federal payments require effort to verify citizenship
By Lisa Rapaport -- Bee Staff Writer
Published 2:15 am PDT Sunday, May 29, 2005
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New federal funds to help California hospitals cover the costs of treating illegal immigrants have many in the state's medical industry puzzling over how to ask patients about citizenship without making them afraid to seek care.

Earlier this month, federal health officials announced plans to spend $1 billion nationwide over the next four years on emergency care for undocumented patients. California will get more than any other state - $71 million in fiscal 2005 - in the first federal effort to cover costs for patients who are not U.S. citizens.

To receive the money, hospitals must ask patients a series of questions designed to determine whether they are in the country illegally. Among other things, patients would be asked if they have a foreign birth certificate or driver's license, a border-crossing card from Mexico or a U.S. Social Security number.



The questions stop short of directly asking patients if they are U.S. citizens, due in part to protests from California hospital executives and advocates for patients and immigrants who feared such blunt queries would make the ill and injured afraid to seek care.

"When there was talk of asking the citizenship question directly, our concern was that patients would not come in, and if they had a communicable disease that would be a major public health problem for everybody," said Duane Dauner, president of the California Healthcare Association, a hospital trade group.

Because both the funding and the questionnaire that accompanies it are new, no one is sure whether the indirect questions about citizenship will stop people from going to hospitals.

"The devil is in how this is implemented" said Francisco Estrada, director of public policy for the Mexican American Legal Defense and Education Fund. "It is possible some hospitals will ask flat-out about immigration status, and it is possible that some patients will fear deportation if they go to the emergency room."

In Northern California, many hospitals are too far from the border with Mexico to track the number of undocumented immigrants they see or the cost of treating them. Many hospital executives said they weighed ethical concerns against potential financial gains in considering whether to take the new federal money.

UC Davis Medical Center in Sacramento will not apply for its share of the new immigrant health funds, said its chief financial officer, William McGowan.

"We have never limited care to people who can show proof of citizenship," McGowan said. "Asking questions now to determine citizenship would put some of our patients through a lot of hoops to get what amounts to not that much money from the feds."

UC Davis does not track the number of immigrants - undocumented or not - that it treats.

With more than 500 California hospitals eligible for the federal funds for immigrants, McGowan said he would expect his facility to get, at most, $142,000 a year. "That's not nearly enough money for us to even consider doing something that for me personally raises an ethical red flag," he said.

At Fremont-Rideout Health Group, which has one hospital in Marysville and another in Yuba City, the man in charge of emergency services is not yet sure whether he will go after the immigrant health funds. Nor is he sure exactly how many illegal immigrants the hospital sees.

"I believe asking direct questions about citizenship could interfere with patient care, and right now we are looking at how to ask the indirect questions so they don't do the same thing," said Brad Danby, director of ambulatory and critical care services at the hospitals.

There is far less ambivalence about the federal money and the required questions in Southern California, where many hospitals already ask citizenship questions to determine if patients are eligible for care.

Los Angeles County spends an estimated $340 million a year on care for undocumented immigrants at its five hospitals, said John Wallace, with the county health department.

"In our system we treat people regardless of their ability to pay and regardless of citizenship status," Wallace said. "But we do ask them to prove residence in Los Angeles County because that is who we are funded by the taxpayers to serve."

Scripps Health, a nonprofit chain of five hospitals in San Diego County, also will take the money and ask the questions necessary to get it, said Chris Van Gorder, president and chief executive officer of the system.

"It's a huge step for the federal government to start paying some of the bill for illegal immigrants," said Gorder, who has one hospital seven miles from the Mexican border that lost $14 million last year because it treated a high number of uninsured and undocumented patients.

At Scripps, one in four uninsured patients is an illegal immigrant. Van Gorder said the new federal funds will cover about 15 percent of the total cost of the undocumented patients' care.

"Like many others, we have some reservations about the questions," Gorder said. "But we think we can ask them with sensitivity."

About the writer:

* The Bee's Lisa Rapaport can be reached at (916) 321-1005 or lrapaport@sacbee.com.