Thread: Medicaid denials dire news for some illegal immigrants

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Medicaid denials dire news for some illegal immigrants

By BRIAN FEAGANS
The Atlanta Journal-Constitution
Published on: 01/27/06
Each knock at the front door echoes with anxiety at Fernando Benitez's two-story home in Norcross.

Benitez, a 21-year-old illegal immigrant with muscular dystrophy, learned this month that Georgia has cut off his Medicaid. It's part of an effort to reduce the number of people using the system that provides health care for the poor and disabled. For the past four years, Medicaid had paid for the respirator and feeding tubes that keep Benitez alive.

"This is our worst fear," Cesario Castrejon, Benitez's grandfather, said in Spanish over the dull hum of a respirator at his grandson's side. "That they're coming to take the machine."

Georgia used to be more generous with its Medicaid benefits. But the Georgia Department of Community Health, facing a federal audit, has tightened its Medicaid eligibility requirements to match those of the federal government.

Part of that effort involves making sure Medicaid is only covering illegal immigrants in "emergency" cases. Benitez learned this month that his condition doesn't qualify as an emergency but is considered a chronic illness. His Medicaid claims were denied for the first time this month, but he plans to appeal that decision with the help of an Atlanta law firm representing him for free.

Until this month, Medicaid had covered the cost of the equipment, medication and a nurse (or nurse's assistant) for Benitez. But Community Health began more closely scrutinizing claims from illegal immigrants seeking emergency care this month, said Julie Kerlin, a spokeswoman for the department.

Some patients on Medicaid before are being denied now because their conditions are considered chronic rather than emergency cases, said Kerlin, whose agency administers Medicaid in Georgia. She said it's too early to tell how many are being denied claims this month that were approved in the past.

The emergency Medicaid funds were never meant to provide long-term care, Kerlin said. The program paid out $88 million to 21,000 illegal immigrants during fiscal 2005 in Georgia, Kerlin said. Much of that money covered the care of pregnant women and their babies.

Health advocates say that while the effort is undoubtedly eliminating fraud, it also has cut off funds for preventative care that could save taxpayers money in the long run. Pregnant women with diabetes, for example, no longer are getting Medicaid for their insulin, said Maria Francis, administrator of the Centro Internacional de Maternidad (International Maternity Center), a network of four maternity clinics north of Atlanta.

Francis fears that the expectant mothers will stop taking insulin and wind up with a trip to the hospital that not only costs taxpayers more but also puts two lives at risk.

"I understand what the government is trying to do," Francis said. "There is a lot of abuse. But we're going to have more dead babies and more dead moms."

Francis said 54 women who normally would have been approved for Medicaid have been denied so far this month at CIMA clinics. That's about 5 percent of her clients, she said.

Kerlin said she couldn't comment on specific cases. But she said the department was working on transition plans for longtime Medicaid recipients such as Benitez who will no longer get emergency assistance.

"We will do everything we can to assist in the transition of this individual to alternative resources," Kerlin said.

No word of such a plan had reached Benitez by this week. "I'm scared," he said in Spanish as he watched TV from the single bed where he spends most of his time.

Benitez's mother, Nelida Castrejon, said a social worker in Lawrenceville told her last week that there was nothing she could do. The company that rents and maintains the respirator and feeding tubes has said it will begin charging the family, she said.

Castrejon said the difference between a "chronic" and "emergency" condition is mere semantics in her son's case. Take away his respirator and feeding tube, she said, and a chronic condition quickly becomes an emergency for her only child.

"If someone like Fernando doesn't need it," she said in Spanish, "then who needs it?"

Linda Lowe, a consumer health advocate, said that just because care is provided over a long period of time doesn't mean it's not of an emergency nature. "There are situations where if you don't do the service, the person will certainly end up back in the emergency room," she said.

Illegal immigrants aren't the only ones feeling the pinch as Georgia follows the more strict federal standards. Many children with multiple disabilities who used to receive Medicaid no longer do. The children require constant monitoring at home, much like Benitez.

Castrejon, 45, said she and her husband divorced as Benitez's muscular dystrophy — a degenerative muscle disease — grew worse in Mexico.

Constantly lifting Benitez took its toll on the diminutive Castrejon, who suffered two hernias and threw out her back. She decided to move with Benitez to her parents' home in Norcross in 2000. She said her entire support network — parents, six siblings and extended family — all live in metro Atlanta and other parts of the Southeast.

A year later, Benitez choked on a piece of chicken and suffered respiratory arrest, Castrejon said. That's when he began using the respirator and feeding machine covered by emergency Medicaid, she said.

While muscular dystrophy has greatly weakened Benitez physically, his mind remains sharp. He follows Mexican politics closely and reads the online version of El Universal, a Mexico City daily newspaper, every day on the laptop computer that the Make-A-Wish Foundation gave him three years ago. His other passion is the Cruz Azul, a Mexican soccer team whose logo is featured on Benitez's pillow and a framed team picture in his room.

Castrejon, who doesn't work so she can care for Benitez, said she can't afford to pay for the regular maintenance of the respirator and feeding machine, let alone the equipment itself.

Frances Kirk, Benitez's former nurse and now a close family friend, said the family has gotten a couple of breaks this week. She said Catholic Social Services has offered to pay for two months of Benitez's medication, which costs $1,000 per month. And a woman called Thursday to say she was going to open a bank account and try to raise money for Benitez.

Kerlin said her department decided to make changes to its Medicaid program after being notified that the federal government was going to audit the state's 2006 accounts next January.

The renewed focus on abuse also comes one month after Gov. Sonny Perdue instructed state Medicaid administrators to institute a new verification requirement for applicants. Starting Jan. 1, applicants for Georgia's Family Medicaid had to provide documents such as W-2 forms, pay stubs, or income tax returns before becoming eligible for benefits.

"This new requirement will reduce fraud in the taxpayer-funded health care system and ensure that Medicaid recipients are legal residents entitled to public assistance," Perdue said at the time.

Perdue spokeswoman Heather Hedrick said this week that Community Health decides who qualifies for the emergency exemptions. That's the kind of exemption Benitez had until this month.

Staff writer Jim Tharpe contributed to this article.

•A version of this article may appear in today's Metro section.

Tell it to Viscente Fox. How did this guy get here in the first place?

yeah - i mean Georgia has been a poor state for what a hundred years???? or more -

My ex-husband's grandmother was operated on the kitchen table , in georgia ,and died .no reporter came out to do a press release about it.
this story didnt have a happy ending. MY ex's father was put into an orphanage - because the relatives coudn't afford to take in all the kids. and he was worked as a share cropper by the owners- no education for him , no free anything.

Rick Bragg- Ava's man- read his book about what it was like to grow up poor in the south- he covers medical care: If you didn't have money - you died. his mother lost a daughter because they had no cash to pay for the doctor .
then . these illegals have the most outrageous expectations from the united states. this infuriates me. My grandparents lost their house in the depression- cause even though my grandfather was an accountant for the railroads- they had no medical insurance and when my mother became deeply ill and was hospitalized for a month- they lost everything.
Did they call a reporter and talk about how unfair it was? no. they bought a piece of land out in the country and my grandfather and uncles built a new house- with no indoor plumbing. before that they had lived in a really nice neighboorhood in the city--

yet, we never hear from the mexican goverment or the hondurean government about picking up the tab.


this was the united states just a generation ago- then these illegals come here and tell us we're lazy and don't want jobs .


it just infuratiates me- we could all post stories about how hard we and our ancestors have worked- yet the media isn't interested-

here in oregon - a few years ago- a little american boy had a disease that the oregon health plan refused to cover and he died . they were americans. it happens.

She said her entire support network — parents, six siblings and extended family — all live in metro Atlanta and other parts of the Southeast.

Sounds like there is plenty of family here. Perhaps these people could chip in to care for this young man now and when he's sent back home. These people could learn to change iv bags, give injections, give CPR, feed through feeding tube, etc. My family had to learn.

We simply cannot continue to take in and support all the sick people from all over the world. At some point, do-gooders must start advocating for human rights in home countries.