Hospitals and physicians will always care for all patients in need who come to emergency departments, regardless of their ability to pay or their immigration status. CHA has long advocated that the federal government acknowledge the cost of providing care to undocumented patients, and appropriate sufficient funds to cover the cost of their emergency and follow-up care.

Repeatedly, the U.S. Border Patrol delivers to hospitals undocumented patients who need health care. Since these immigrants have not been arrested, the Border Patrol refuses to pay for their care. Hospitals should not be put in a position of immigration enforcement. Currently, California provides emergency and obstetrical services to individuals who lack specific documentation of immigration status. CHA supports a federal reimbursement policy that honors the separation of health care delivery and immigration enforcement. Hospitals, health systems and other health care providers cannot be required to act as functionaries of the Immigration and Naturalization Service by being asked to interrogate patients about citizenship status. Because of the sensitive nature of the provider/patient relationship, any other approach would endanger the public’s health.

The Medicare Modernization Act included a provision known as Section 1011, which authorized $250 million per year to reimburse hospitals, physicians, and ambulance services for the cost of care associated with the treatment and transportation of undocumented immigrants. To be eligible for Section 1011 reimbursement, the service must be provided as a result of obligations imposed by the Emergency Medical Treatment and Active Labor Act. The law set forth a complicated formula for dividing the $250 million annual appropriation — California receives approximately $71 million per year. Unspent funds form a fund balance, which providers in the state can draw down in future years.

Congressional authorization for Section 1011 expired in 2008, but several members of Congress, including those from California, have expressed an interest in re-authorizing the program. Section 1011 reimbursement is administered by the Centers for Medicare & Medicaid Services (CMS); claims are paid by the CMS contractor Trailblazer Health Enterprises Inc.