Wednesday, December 05, 2018

Proposed immigration policy change could hurt rural hospitals by reducing Medicaid enrollment

According to a report from Manatt Health, part of a lobbying firm, a proposed change to the "public charge" immigration rule would endanger $17 billion in Medicaid reimbursements for U.S. hospitals, which would especially hurt the rural hospitals that depend more on such reimbursements.

"The rule proposed by the United States Citizenship and Immigration Services would require most immigrants seeking green cards to show that they have a middle-class income: specifically, more than 250 percent of the federal poverty line (about $62,750 for a family of four)," S.E. Smith reports for Talk Poverty, a service of the liberal Center for American Progress. "Immigrants could also fail the test if they have received government benefits, including Medicaid and Medicare Part D, in the past or if officials feel they are likely to receive them at any point in the future. The test would also penalize use of the Supplemental Nutrition Assistance Program . . . and housing assistance programs."

Researchers for Manatt Health found that the change could lower Medicaid enrollment even for legal residents who are eligible for coverage and would not be subject to the new rule because they might fear accidentally breaking the law. The same fears are already driving down enrollment in the Supplemental Nutrition Assistance Program (formerly food stamps), especially in households with a mix of legal immigrants, citizens, and/or undocumented immigrants, Smith reports. The change could affect as many as 13.2 million immigrants on Medicaid who use almost $70 billion in Medicaid and Children's Health Insurance Program services every year.

Here's the rural rub: "When people begin to unenroll from Medicaid, the rise in uninsured people who still need health care will lead to fewer Medicaid reimbursements and a corresponding increase in uncompensated care costs," Smith reports. "That will be particularly hard on rural hospitals, in part because rural communities rely more heavily on Medicaid coverage than their urban counterparts due to the lower number of other insurance options and high poverty rates."

While most immigrants live in urban areas, they're an increasing presence in rural areas, and the loss of their Medicaid dollars could badly hurt already-struggling rural hospitals. That's already happening in Texas, which has a large immigrant population and where changes to Medicaid policy have hit rural hospitals hard, Smith reports.

Manatt Health said it prepared the report for America’s Essential Hospitals, the Association of American Medical Colleges, the American Hospital Association, the Catholic Health Association of the United States, the Children’s Hospital Association, and the Federation of American Hospitals.

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