Undocumented patients face treatment dilemma
For undocumented immigrants, finding health care can be difficult. Treatment at home may be the best option for many illnesses, and federally qualified health centers, such as the Albert Galvan Health Clinic in North Fort Worth, can become medical homes.
When it comes to the hospital system, though, the health care industry can be intimidating, according to those who work in or study hospital systems. There are various reasons for this, such as possible language barriers, fear of being turned in, misconceptions about getting care, but how an undocumented patient is cared for largely depends on the individual health care system.
In Tarrant County, Texas Health Resources, the Baylor Health Care System and JPS Health Network are the large hospital systems that frequently provide care to undocumented patients who are a part of the greater Fort Worth community. Each has its own policy for how to deal with these patients, but being Texas hospitals — and being hospitals in part of a Metroplex that is an international melting pot — means they may see these patients more than health systems in other states without large international populations.
Richard Kurz, dean of the School of Public Health at the UNT Health Science Center, said there is no official ranking of how well each state treats undocumented patients, but states like Texas, California, New York and Illinois, with large immigrant populations, most commonly deal with the issues surrounding undocumented patients.
As the health care communities look for ways to better serve these patients while still serving U.S. citizens, undocumented patients are faced with going through a health care system that may be very different from the system in the country they grew up with. Throw in possible language problems and worries that hospital officials will contact the Immigration and Naturalization Service and have patients deported, and finding care in the U.S. can be daunting.
“It’s hard for Americans with English, or those who’ve been here for many, many years, to work their way through the system,” Kurz said.
One of the most common ways an undocumented patient enters a hospital system is through an emergency department or urgent care center. The Federal Emergency Medical Treatment and Active Labor Act mandates that U.S. emergency departments at hospitals treat patients regardless of their citizen status or ability to pay, and at JPS and Texas Health hospitals (including Texas Health Harris Methodist Hospital Fort Worth), patients are brought in and treated without being asked about whether they are citizens. (No one from the Baylor Health Care System committed to an interview for this story.)
“We don’t denote citizen status anywhere,” said Barclay Berdan, senior executive vice president, system alignment and performance for Texas Health.
If a patient needs a lengthier stay at the hospital, then the admission process does gather more information about the patient, such as whether the patient has insurance. An undocumented patient wouldnÂ’t have insurance, though, and wouldnÂ’t be qualified for federal programs like Medicare or Medicaid, and so at Texas Health they could apply to receive charity care and at Texas Health as well as JPS they can set up a fee-for-service program.
The fee-for-service program isnÂ’t just for undocumented patients, said Robert Earley, president and CEO of JPS Health Network. It would also apply for other people who donÂ’t qualify as beneficiaries of the county hospital, such as those who live outside Tarrant County.
“No one is going to be told, ‘We’re sorry, we just discovered you don’t happen to be a citizen of Tarrant County, so you have to leave,’” Earley said.
Financial plans can be set up to help patients pay for their services, Berdan and Earley said, but when patients are discharged there are often limited options for follow-up or extended care. There are some organizations that offer limited charity care for undocumented patients, and there are federally qualified health centers (although Tarrant County currently only has one), and some physicians or other institutions (like nursing homes) may take on a small number of undocumented patients, Kurz said. But once a patient has exhausted all the care a hospital can give, there often isnÂ’t anywhere go to afterward. Long-term acute care hospitals are generally for-profit, Kurz said, and each also has its own policy regarding undocumented patients. (Repeated phone calls to Kindred Healthcare, which operates six hospitals in the Metroplex, were not returned.)
“Those patients are likely to end up at home,” Kurz said.
One option sometimes offered to undocumented patients is transportation back to their home country. Berdan said if follow-up care canÂ’t be found locally, a patient may opt to have family in his or her native country contribute to care and Texas Health has, on rare occasions, paid for the trip.
“I really can’t quite even remember a case where the patient or the family agreed to that option,” Berdan said.
JPS also keeps this as an option for some patients. Earley recalled an instance last year in which a man from Peru was flown there with assistance from his family and care arranged for him at a facility that met the health systemÂ’s standards.
“We don’t want to take a patient out of JPS and just send them back home,” Earley said. “We want to at least find a facility that meets the qualifications to care for that patient.”
There is some federal assistance available to partially compensate hospitals for emergency and urgent care given to undocumented patients. Most of the funding is in the form of Section 1011 payments, which were started under the Medicare Modernization Act of 2003. For the 2005 through 2008 fiscal years, $250 million each year was set aside to partially reimburse hospitals, and the first payments were issued in February 2006, totaling almost $25.5 million, according to the Centers for Medicare and Medicaid Services.
To date, Texas Health has received about $4.1 million in Section 1011 payments, and JPS was unable to locate its Section 1011 total by the Business Press deadline. Texas Health also provided about $87 million in free care systemwide in 2008, and a portion of that charity care would have gone toward undocumented patients (although thereÂ’s no way to track exactly how much, since those patients arenÂ’t tracked). Of JPSÂ’ patients, about 18 percent are fee-for-service patients, including a portion that are undocumented, and there are several hundred of thousands of dollars available in prescription aid and other programs for those who donÂ’t qualify for any government programs like Medicaid or for the JPS Connection, its tax-supported medical program for Tarrant County residents.
One considerable source of care for undocumented patients — as well as patients who are uninsured or underinsured — are health fairs, Kurz said. In the Metroplex area, many undocumented patients are Hispanic, and events like the Hispanic Wellness Fair, held in the late summer or fall, are a place to get health screenings and tips for managing care. JPS, Texas Health, the UNT Health Science Center, the Albert Galvan Health Clinic, the Tarrant County Public Health Department and many other organizations are part of the Hispanic Wellness Coalition, which oversees the event.
“For many of these folks, this is all the health care they’re going to get during the year. They don’t have another place to go,” Kurz said.
While finding appropriate health care may seem difficult, undocumented patients do have a brighter future the longer they can stay in the country and the more they can progress with their citizenship, Kurz said.
“We know that those individuals, the longer they’re here, the more likely they are to have insurance and the more likely they are to have good outcomes,” he said.
