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U.S. pays for care of illegal aliens
Treatment money for border states

THE NEW YORK TIMES | May 10, 2005
By ROBERT PEAR

WASHINGTON -- The Bush administration said yesterday that it would start paying hospitals and doctors for providing emergency care to illegal immigrants.

The money, totaling $1 billion, will be available for services provided from today through September 2008. Congress provided the money as part of the 2003 law that expanded Medicare to cover prescription drugs, but the new payments have nothing to do with the Medicare program.

Members of Congress from border states had sought the money. They said treatment of illegal immigrants imposed a huge financial burden on many hospitals, which are required to provide emergency care to patients who need it, regardless of their immigration status or ability to pay.

Under the new program, hospitals are supposed to ask patients for documents to substantiate payment claims. But Dr. Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, said a hospital should not directly ask a patient "if he or she is an undocumented alien."

Instead, he said, hospitals can try to establish a patient's status by analyzing the answers to "indirect questions": Is the person eligible for Medicaid? (If so, payment is generally not available under the new program.) Has the person reported a foreign place of birth? Does the person have a border-crossing card like those issued to Mexican citizens? Does the person have a foreign passport, a foreign driver's license or a foreign identification card?

The Bush administration abandoned a proposal that would have required many hospitals to ask patients if they were U.S. citizens or legal immigrants.

"In no circumstances are hospitals required to ask people about their citizenship status," McClellan said yesterday.

Hospital executives and immigrant rights groups had said such questions would deter illegal immigrants from seeking care and could lead to serious public health problems by increasing the spread of communicable diseases.

Cecilia Munoz, a vice president of the National Council of La Raza, a Latino civil rights group, said the new requirements were an improvement over the original proposal but would still discourage some immigrants from seeking treatment.

"Hospitals will have to ask confusing, highly technical questions about immigration documents," Munoz said. "That will create a perception in the Latino community that you have to show your papers in order to get emergency care. That's a misperception, but it may be enough to deter some people from seeking care."

The new program is run by the Department of Health and Human Services. McClellan said the department would not provide information about illegal immigrants to law enforcement officials for use in "routine civil immigration proceedings." But in rare cases, he said, the information may be used in criminal investigations.

The largest allocations this fiscal year are going to California, which will receive $70.8 million; Texas, $46 million; Arizona, $45 million; New York, $12.3 million; Illinois, $10.3 million; Florida, $8.7 million; and New Mexico, $5.1 million.

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