Undocumented Immigrants To Strain Safety-Net Hospitals


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Undocumented immigrants are expected to make up a larger share of Connecticut’s uninsured population next year, putting new financial pressures on safety-net hospitals that provide emergency care to everyone, state and national health experts predict.
The Affordable Care Act (ACA) provides coverage options for legal immigrants, but those in the U.S. illegally cannot apply for Medicaid, even if they are poor, or buy coverage at Access Health CT (the new insurance marketplace), even if they have cash. That means illegal residents without coverage will continue turning to local emergency departments for care at a time when Connecticut hospitals face the loss of millions of dollars in federal and state subsidies to help defray the cost of uncompensated care.
“This is a global problem that isn’t going away. This population (of undocumented residents) is not being addressed by any state or federal initiatives. It’s operating under the radar screen,” said William Gedge, senior vice president for payor relations for Yale New Haven Health System, the state’s largest provider of uncompensated care. The system includes Yale-New Haven Hospital, Bridgeport Hospital and Greenwich Hospital.
The dilemma sheds light on the uncertain future of the so-called safety-net hospitals in Connecticut and the nation as health care reform unfolds. Often located in urban areas, safety-net hospitals treat a disproportionate number of low-income, uninsured, and otherwise vulnerable populations, including undocumented residents. Federal law requires hospitals to provide emergency care, regardless of a patient’s ability to pay or immigration status.
In 2012, Connecticut hospitals spent $233.6 million in uncompensated care, including charity care and bad debt, according to the state Office of Health Care Access. These facilities spent another $868.3 million to cover Medicaid and Medicare reimbursement shortfalls in 2012, reports the Connecticut Hospital Association. Yale-New Haven spent $31.8 million on uncompensated care (charity and bad debt), followed by Stamford Hospital at $25.1 million. Sharon Hospital spent the least, $1.4 million.
Hospital officials expect the budget gaps to widen in 2014 when the health law begins to sharply reduce government subsidies known as “disproportionate share hospital (DSH) payments” on the assumption that more people will be covered by Medicaid or private insurance due to reform. Connecticut hospitals also face a $550 million cut in state funds that previously covered Medicaid expenses.
So far, budget cuts have had a “fairly large impact’’ on hospitals, leading to layoffs and cut backs on new hires, patient services, research and technology – while spending millions to cover uncompensated care and government reimbursement shortfalls, said Stephen Frayne, senior vice president for health policy at the Connecticut Hospital Association.
“Hospitals face the challenge of some how absorbing theses cuts, while providing top quality care,” he said. Ensuring that Medicaid is…
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