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Tough Questions

Hospitals and doctors can get paid for illegal-immigrant care, but there's a catch.

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Where did you attend school? Where were you born? What is your last name?

For most people these questions are routine, but illegal aliens often fear that answering such questions could get them deported. The issue got more complicated last week when the federal government approved health-care reimbursement payments to hospitals and doctors across the country to help recoup the expense of providing services to illegal immigrants. Costs for these services have skyrocketed in recent years, hurting hospitals financially and forcing doctors to provide services free of charge.

Under the new plan, the Centers for Medicare and Medicaid Services (CMS) will distribute $1 billion over the next four years. Two-thirds of the money will go to health-care providers based on the estimated number of undocumented aliens in each state. The remaining third will be distributed among six states with the highest number of undocumented alien arrests, including the border states of California, Texas, and Arizona.

But there's a catch: To receive the quarterly reimbursements, hospitals must prove that they are treating illegal immigrants by questions such as those above. But the questions can frighten patients who are in the U.S. illegally and make them less likely to seek treatment.

"Word will get out to the immigrant community that the funds are there and that these are the questions that the hospital is asking," says Dr. Stuart Polly, chief medical officer at the Regional Medical Center of Memphis (the Med). "It's going to be uncomfortable for our staff to ask them, and it's going to be uncomfortable for the patients to answer them. I'm sure they would like us to recover the money, but at the same time they don't want to jeopardize their personal status."

Polly is no stranger to immigrant issues, having spent years at a border hospital in El Paso, Texas. "I think it's a good thing that the federal government has now realized that it costs to care for this population and is willing to put some money into emergency care," he says.

According to the federal Division of Immigration and Naturalization Services (INS), more than seven million illegal aliens live in the U.S. Approximately 46,000 illegal immigrants live in Tennessee.

The Med is one of several Tennessee hospitals vying for a share of the state's $1 million allotment for fiscal year 2005. While the Med has no way of knowing what percentage of its patients are in the country illegally, the foreign patient population has increased exponentially. In 2004, the number of Hispanic patients -- the Med's largest foreign-born population -- almost doubled from 2003.

(The Med is also seeing an increase in Asian and African patients. The federal government requires that translator services be provided for non-English-speaking patients. Those who speak a more common language, such as Spanish, are assigned interpreters. For more unusual languages and dialects, translations are done by telephone.)

CMS payments only reimburse hospitals for the "stabilization" of patients. Costs for treatments and follow-up hospital visits are not covered. This exclusion has spurred protests from health-care providers, who say they need additional funds for follow-up care.

"No hospital is going to release a patient before they're ready, and there's much more to treatment than stabilization," Polly says. "The emergency room visit or the trauma center bills will be considered if we bill them correctly and if we have collected the indirect information on a patient's immigration status. The remainder of their hospital stay will not be covered, nor will the cost of returning the patient to their home country if that is necessary. It's kind of a mixed message."

The Med staff has not yet developed a protocol for the indirect questioning and subsequent filing of forms to receive CMS payments.

"I think hospitals across the state will look at the impact for them and decide whether it is worth participating [in the program]," says Polly, adding that the Med will continue to provide care for all patients, regardless of immigration status. "There's no question about that," he says.

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