Make us your home page
Instagram

Hospitals battle Medicaid rule changes over undocumented immigrants

TALLAHASSEE — Hospitals throughout Florida are challenging a state rule that limits payments to treat undocumented immigrants.

The hospitals say the Agency for Health Care Administration made the rule without following the proper procedures and unfairly wants them to reimburse the state for some of the Medicaid payments used to treat immigrants who are in the United States illegally.

At issue is a technical dispute over how much Medicaid pays for emergency services and when an emergency patient turns into a "stable" patient still in need of care. AHCA's position is that Medicaid covers emergency care for undocumented patients, but not the ongoing treatment needed to keep the patient stable.

The rule could save taxpayers "millions and millions of dollars," but it would burden large hospital systems that provide loads of charity care, said Joanne Erde, an attorney representing the hospitals.

"What the state is saying is: 'We don't care if the patient is in the hospital or not or if the services are medically necessary, we're not going to pay for anything beyond the point of stabilization' — whatever that is," Erde said. "And they're applying it retroactively, back to 2005, in order to get money back from the hospitals."

Erde's clients filed a challenge with the Division of Administrative Hearings on Wednesday. They're not specifically challenging the rule affecting Medicaid reimbursements, but the fact that it was implemented without public hearings.

AHCA said it never changed its policies, but simply conducted an audit to enforce what was already on the books.

"Our policy has not changed," said AHCA spokesperson Shelisha Coleman. "We did an audit that raised suspicion that the hospitals were treating illegal aliens for emergencies and continuing treatment after the emergency had stabilized."

AHCA did not provide data on how much money would be saved from the audit.

AHCA launched the audit last year to look over the medical records of undocumented immigrants going back to 2005. The goal of the audit was to determine at which point the immigrant became "stabilized," and deny any Medicaid reimbursement for care given after the stabilization point.

"There will be no reconsiderations process for this project. All determinations are final," read a presentation given by a Medicaid review firm under contract with AHCA.

Hospitals say the state's demand to return payments made years ago is particularly unfair because the payments were approved by a state-mandated third-party gatekeeper who performed preliminary reviews of hospital claims.

The case came as a surprise to the state's largest provider of charity care, Miami's Jackson Memorial, which isn't listed as a plaintiff in the challenge.

About 8 percent of Jackson's clients are likely undocumented, said Carlos Migoya, the head of Jackson. He said he was unaware of the challenge or the rule change.

Despite the potential hit to their wallets, the issue has been a sleeper in the hospital industry. Tony Carvalho, lead lobbyist for the Safety Net Alliance of Florida, said he hadn't heard of the challenge. But, he said, South Florida hospitals are particularly on the hook for providing care for undocumented immigrants. Tampa Bay area hospitals run a distant second, he said.

Several hospitals in immigrant-heavy areas — including St. Anthony's Hospital in St. Petersburg, Hialeah Hospital and Palmetto General Hospital in Hialeah — joined the challenge.

Though the case was just filed, the rule has been years in the making. It was first proposed in the summer of 2010 under then-Gov. Charlie Crist, who was running for U.S. Senate at the time.

The federal government, however, also has a say. It makes the rules governing Medicaid, a massive federal-state program that pays health costs for the poor and uninsured. About 3.3 million people use some type of Medicaid service in Florida, where the program accounts for about $21.4 billion in spending.

A 2003 AHCA study showed that about 70 percent of illegal immigrants accessed Florida hospitals by going to the emergency room. The state is home to an estimated 825,000 undocumented immigrants.

Coleman said AHCA would fight back against the charges.

"We are reviewing it and we plan to respond," she said.

Marc Caputo can be reached at mcaputo@miamiherald.com. Toluse Olorunnipa can be reached at tolorunnipa@miamiherald.com



Hospitals battle Medicaid rule changes over undocumented immigrants 08/17/12 [Last modified: Friday, August 17, 2012 10:02pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times

    

Join the discussion: Click to view comments, add yours

Loading...
  1. Despite Hurricane Irma, Hillsborough remains on pace to unlock hotel tax that could pay for Rays ballpark

    Tourism

    TAMPA — Despite the threat of a catastrophic storm, it was business as usual at many Hillsborough County hotels in the days before Hurricane Irma bore down on the Tampa Bay region.

    The Grand Hyatt near TIA closed during Hurricane Irma, but many other Hillsborough hotels were open and saw an influx.
  2. New Graham-Cassidy health care plan stumbles under opposition from governors

    Nation

    WASHINGTON — The suddenly resurgent Republican effort to undo the Affordable Care Act was dealt a blow on Tuesday when a bipartisan group of governors came out against a proposal gaining steam in the Senate.

    Sen. Lindsey Graham, R-S.C., joined by, from left, Sen. Roy Blunt, R-Mo., Majority Whip John Cornyn, R-Texas, Sen. John Barrasso, R-Wyo., Sen. Bill Cassidy, R-La., Senate Majority Leader Mitch McConnell, R-Ky., and Sen. John Thune, R-S.D., speaks to reporters as he pushes a last-ditch effort to uproot former President Barack Obama's health care law, at the Capitol in Washington, Tuesday, Sept. 19, 2017. To win, 50 of the 52 GOP senators must back it -- a margin they failed to reach when the chamber rejected the effort in July. [/J. Scott Applewhite | Associated Press]
  3. Early estimates peg Hurricane Irma damage at as much as $65B

    Banking

    The damage totals from Hurricane Irma are still being tallied, but early numbers are in: As of Tuesday, the storm is estimated to have caused between $42.5 billion and $65 billion of damage. That's according to a Tuesday release by Irvine, Calif.-based analytics company CoreLogic.

    Hurricane Irma is estimated to have caused up to $65 billion in damage, said analytics company CoreLogic. Pictured is 
Hermilo Munoz Castillo as wades down a flooded street to check on his home in southern Collier County, Fla. after Hurricane Irma passed. | [LOREN ELLIOTT | Times]
  4. Port Tampa Bay makes public/private commitment for $60 million expansion project

    Business

    TAMPA — Port Tampa Bay approved a public-private partnership agreement with four other entities to divvy up who will pay for a $60 million widening and extension of the Big Bend Channel.

    Port Tampa Bay approved a participation agreement with the U.S. Army Corps of Engineers, Florida Department of Transportation, Tampa Electric Company and Mosaic Company at the port's monthly board meeting on  Tuesday. Port Tampa Bay President & CEO Paul Anderson signs the agreement as Ram Kancharla; Port Tampa Bay's vice president of planning & development, Brandon Burch; project manager at United States Army Corps of Engineers, Lois Moore; of Alcalde and Fay and Charles Klug; Port Tampa Bay principal counsel, and Tim Murphy; deputy district engineer of the Army Corps., looks on. [Company handout]
  5. One of St. Petersburg's newest condo projects is sold out

    Real Estate

    ST. PETERSBURG — Reflecting the continued demand for condos in downtown St. Petersburg, The Salvador, completed earlier this year at 199 Dali Blvd., has sold out. Records show that a 2-bedroom, 2-bath unit sold Friday for $620,000 in an all-cash deal. Two other units — a 3-bedroom, 2-bath penthouse and a …

     Reflecting the continued demand for condos in downtown St. Petersburg, The Salvador, completed earlier this year at 199 Dali Blvd., has sold out. 
[Rendering courtesy of aalliiggnn LLC]