Lost in the furor over whether or not illegal immigrants
would receive government funded health insurance under the Democratic health
reform bill is the fact that federal and state tax money already goes to pay
for the emergency care of illegal immigrants under the Medicaid program. In the case of Texas, the annual total is a princely $300 million in care for undocumented workers.
Medicaid provides medical assistance to low-income
individuals and individuals with disabilities. The federal and state
governments jointly fund and administer the Medicaid program. While the states
have flexibility in designing and operating their program, it must comply with
federal requirements — including the requirement that funding for patients who
are illegal immigrants be limited only to emergency care.
A recent audit (pdf) of the Texas Medicaid program by Department
of Health and Human Services (HHS) Inspector General (IG) found that while a
majority of claims complied with the state's definition of emergency care, a
significant percentage were for non-emergency care.
During a one-year period, the state Medicaid agency processed
over 300,000 claims for illegal immigrants totaling approximately $314 million,
plus $148,000 for prescription drugs. Of this total, approximately 70 percent
was for labor and delivery services, which is considered appropriate use of
these funds.
The IG examined a sample of 854 medical claims from October
1, 2004 through September 30, 2005 and determined that 23 percent either lacked
proper documentation of the care provided or were for non-emergency care after
the patient had been stabilized.
In one case a patient with cervical cancer received
chemotherapy treatments at a hospital and the provider submitted claims with
diagnosis codes for chemotherapy and convulsions, which is an emergency
diagnosis. While the patient had a history of a seizure disorder, she was not
having convulsions at the time of the chemotherapy treatment so that hospital
stay should not have been paid under Medicaid.
The IG recommends the state strengthen its policies and
procedures to prevent future Medicaid payments for non-emergency services
provided to illegal immigrants and require that officials responsible for
reviewing claims be familiar with federal and state requirements and have
medical backgrounds.
Are we ready, as a nation, to deal with the questions and difficult cases involving what constitutes appropriate health services for illegal immigrants living within our borders?
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