Emergency Medicaid and Undocumented Immigrants
Medicaid is a government program that provides access to healthcare at no or reduced cost to people who cannot otherwise pay for medical treatment; it uses government funds to reimburse hospitals or clinics that provide emergency care to people who qualify. This program has specific requirements on who is eligible to receive aid from including: age limits, disabilities, income, and more. Emergency Medicaid is used when there Is a sudden need for medical treatment, or when there is “a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms or sufficient severity (including severe pain) such that the absence of immediate medical attention could be expected to result in [adverse results].” (Sean Elliott, 152). It is currently the only government program that does not restrict access based on citizenship level, meaning that immigrant’s, legal or illegal, have access to emergency Medicaid services, if they meet the other requirements. However, there are again limitations to what emergency Medicaid can cover. For example, they do not cover organ transplants or certain chronic diseases, only sudden-onset critical conditions. This limited coverage leads to large gaps in the type of care and treatments that people who qualify can receive, and has incited many debates over the legality and morality of this issue.
As more undocumented immigrants came into the country, there became more controversy over what should be included. Since the number of people who were eligible for emergency Medicaid was growing, more money and resources were being used for these undocumented immigrants. A study done by C. Annette DuBard and Mark W. from 2001 to 2004 in order to determine how the increase in immigration was affecting emergency Medicaid claims. It was found that 99% of people who used emergency Medicaid funds were undocumented immigrants, 95% were females, and 89% were people between the ages of 18-40 (nih.gov). It was also determined that 82% of spending was for childbirth and complications of pregnancy, while other prevalent areas of spending were for chronic conditions such as renal failure, gastrointestinal disease, and cardiovascular conditions (nih.gov). Even though this study was done a while ago, it shows some important trends. The study mentioned above was done in response to an increase in immigration rates, but since the study concluded, immigration has only increased. Based on a census done in 2015, over 13% of the population in the United States are immigrants, translating to over 43 million people (migrationpolicy.org). Most recently though, there have been new policies preventing immigration. There are few statistics on the exact changes in immigration, but it is likely that the numbers will decrease if there continues to be added restrictions on immigration.
There were still large holes in the coverage, but it seemed to be covering more than in past years, until 2007. In an article by Benjamin Sommers, he states that less than 60% of the 8.25 million undocumented Latinos do not have access to regular medical services, so the majority rely on whatever coverage they can get from emergency Medicaid. There is a large disagreement on how broad the emergency Medicaid coverage goes. Some say that only treatments pre-stabilization should be covered, but others disagree and argue that post-stabilization treatments should be included as well, to give more thorough medical care.
In 2007 the debate about what is covered by emergency Medicaid was sparked when the government turned down a bill that would have changed immigrant healthcare, and one way was to increase what was covered by emergency Medicaid. One of the main points of debate was if emergency Medicaid should cover the post-stabilization costs of treatments. Since many people who use emergency Medicaid services do not have access to insurance, these costs can be substantia, and the implications of not receiving post-stabilization care can have serious consequences. Current emergency Medicaid procedures state that hospitals or other clinics only need to provide care until the patient is “stable.” So, for example, if a patient received emergency surgery, the cost of the operation would be covered, but not the cost of any post-treatment care. Some say that this calls for emergency Medicaid to expand their polices to provide the necessary care for patients to make full recoveries. Many physicians are arguing for a broader definition of what can be covered by emergency Medicaid because they feel an ethical and legal obligation to give the best possible care, even at the expense of their employers or other healthcare services.
In areas with a high population of immigrants, emergency Medicaid costs have caused healthcare providers to limit their coverage and treatments even more or in extreme cases, shut down entirely. This affects what legal residents have coverage for or access to, as well as illegal immigrants. According to Sean Elliott, Congress has made it quite clear in their polices that undocumented immigrants should not have access to healthcare treatments outside of emergency Medicaid, possibly because it may take resources away from legally residing citizens. The argument is that people who are legally in the country should have more access to medical resources and treatments than illegal residents because they have more legal rights to these resources than the illegal residents.
Under the Affordable Care Act, Medicaid coverage was expanded. This was done by lowering healthcare costs, offering coverage for more conditions, and upgrading existing eligibility standards (Medicaid.gov). However, based on the new administrations current position on immigration and spending, it is likely that there will soon be cuts in Medicaid and the care that is provided. Healthcare is a constantly changing field, and emergency Medicaid is just one of the programs that is under scrutiny for ethically and legal reasons.
Resources:
DuBard, C. Annette and Massing, Mark W.
April 25, 2007 Trends in Emergency Medicaid Expenditures for Recent and Undocumented Immigrants. American Medical Association [Vol. 297, Issue 16].
Elliott, Sean
2008 Staying within the Lines: The Question of Post-Stabilization Treatment for Illegal Immigrants Under Emergency Medicaid. Journal of Contemporary Health Law and Policy [Vol. XXIV].
Emergency Medicaid
Emergency Medicaid, accessed on February 5, 2017, http://www.emergencymedicaid.net/
Managed Care Weekly Digest
March 26, 2007 Medicare and Medicaid; Emergency Medicaid for Immigrants Goes to Childbirth. NewsRX Issue 6.
Marrow, Helen B.
March 2012 Deserving to a point: Unauthorized immigrants in San Francisco’s universal access healthcare model. Social Sciences & Medicine [Vol. 74, Issue 6].
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