Our brother’s keeper? How far should taxpayers go to fund others’ health care?


By William Patrick | Florida Watchdog

TALLAHASSEE, Fla. — A state appellate court has removed any confusion over whether Floridians are footing the health-care bill for undocumented immigrants.

Taxpayers are indeed paying for emergency room visits, but how much deeper into our wallets should we go?

MEDICAID FOR ILLEGALS: A battle between the state and Florida hospitals has taxpayers on the hook and undocumented immigrants facing stricter emergency room standards.

The controversy involves the Florida Agency for Health Care Administration — responsible for the federal-state Medicaid program in Florida — and a group of hospitals that want to maintain a more generous level of funding.

The dispute is years in the making and involves hundreds of millions of dollars.

The 1st District Court of Appeals heard oral arguments last week but did not issue a final ruling.

Before 2010, the state applied a “medically necessary” standard to determine how long undocumented immigrants could stay in state hospitals. But the Centers for Medicare and Medicaid Services, a federal agency, requires states only to “stabilize” patients.

The feds want their money back, all $174 million of it.

“The federal agency has taken the position that ‘stabilization’ is the point, and (AHCA) is going to have to pay back the overpayments,” said Tracy Lee George, assistant general counsel for AHCA. “Which means the taxpayers are going to have to pay back the overpayments.

Medicaid is already Florida’s single largest budget item, and annual health-care costs typically outpace state revenue growth.

AHCA changed its hospital reimbursement policy in 2010 to comply with federal law. An administrative judge, however, ruled two-years later the agency failed to follow the proper rule-making process that would have allowed hospitals a say in the final outcome.

“You’re right, this is about recoupment,” said Joanne Erde, the hospitals’ attorney. “But it doesn’t allow them to change what they’re doing without going through rule-making.”

For taxpayers, it’s a dispute largely without a distinction. They’re paying, either way.

Florida spent $214 million in 2011 on 31,000 patients, according to Kaiser Health News. Emergency Medicaid amounts to $2 billion annually nationwide and is overwhelmingly consumed by undocumented immigrants.

“The lion’s share goes to reimburse hospitals for delivering babies for women who show up in their emergency rooms, according to interviews with hospital officials and studies,” Kaiser reported.

Ira Mehlman, media director for the Federation for American Immigration Reform, which seeks to limit illegal immigration, says emergency care must be provided to those who need it, but with an important caveat.

“If somebody desperately needs health care then it definitely has to be provided until the person is stabilized,” Mehlman told Watchdog.org.

“But if we enforce existing immigration laws, then obviously people won’t be here to show up at emergency room doors,” Mehlman said.

From a strictly cost point of view, child-bearing is just the beginning.

Under the 14th Amendment, children born to undocumented parents in the United States automatically become citizens and are entitled to the same means-tested benefits as legal residents.

“Given what we know economically about illegal immigrants, they tend to be poorer than the rest of the population and their children qualify for all relevant benefits based upon their parents’ income,” Mehlman said.

Florida hospitals are caught in the middle of providing medical services and relying on the state and federal governments to reimburse them. A broader interpretation would allow for more funding but would likely come at the expense of state taxpayers.

There are limits, however. Emergency rooms generally do not provide treatment for chronic conditions such as chemotherapy, physical therapy or ongoing prescription medications. Undocumented immigrants can obtain these types of services through community health centers and charitable organizations.

The court seemed to acknowledge a misstep in AHCA’s rule-making responsibility, but also outlined the agency’s authority.

“If we affirm this case, then the bottom line is AHCA could go in tomorrow and adopt a (new) rule,” said Justice James R. Wolf of the 1st District Court of Appeals. “So effectively, what we’re talking about is a recoupment for past services.”

The state agreed, saying, “The $174 million is a big issue, which taxpayers will be responsible for.”

Contact William Patrick at wpatrick@watchdog.org