WASHINGTON - The federal government is offering $1 billion to hospitals that provide emergency care to undocumented immigrants. But to get the money, hospitals would have to ask patients about their immigration status, a prospect that alarms hospitals and advocates for immigrants.
When Congress decided to provide the money last year, state officials and hospital executives saw it as a breakthrough. For years, they had argued that the federal government was responsible for immigration policy and should cover the costs of medical care for illegal immigrants because it had created the problem. These costs weigh heavily on border states such as Texas, Arizona and California and on states such as New York and Illinois, with large numbers of such immigrants.
The largest allocations are going to California, $72 million a year; Texas, $48 million; Arizona, $42 million; New York, $12 million; Illinois, $10 million; and Florida, $9 million.
But federal health officials, under guidelines developed in the last couple of weeks, said hospitals had to ask questions about immigration status to make sure the money would be used as Congress intended, for "emergency health services furnished to undocumented aliens."
Hospital executives and immigrant rights groups said the questioning would deter undocumented immigrants from seeking hospital care when they need it, and some hospitals said compliance might cost them more than they would receive in federal aid.
The Department of Health and Human Services wants hospitals seeking reimbursement to ask patients these questions, among others:
"Are you a United States citizen?"
"Are you a lawful permanent resident, an alien with a valid current employment authorization card or other qualified alien?"
"Are you in the United States on a nonimmigrant visa" of the type issued to students, tourists and business travelers?
"Are you a foreign citizen who has been admitted to the United States with a 72-hour border crossing card?"
Under the new guidelines, photocopies of passports, visas, border crossing cards or other documents that establish the patient's status should, if available, be included in the patient's file.
Hospital executives said they would probably have to ask all uninsured emergency patients about their citizenship or immigration status. The government says hospitals must not single out people who "look or sound foreign."
Lawyers say such disparate treatment could violate the Civil Rights Act of 1964, which prohibits discrimination on the basis of race, color or national origin in programs that receive federal aid.