Undocumented Immigrants' Childbirth Is Top Emergency Medicaid Expense

Study of N.C. data shows first look at health care needs of burgeoning population.

TUESDAY, March 13, 2007 (HealthDay News) -- The lion's share of Emergency Medicaid expenditures in North Carolina covers undocumented immigrants' pregnancy and labor complications, a trend that's probably occurring in other states, a new study found.

The findings are one of the first close-up looks at the health care needs of the growing numbers of immigrants in the United States, and they appear to question the monetary costs of excluding undocumented immigrants from routine health care, especially prenatal care.

Other experts agreed.

"Providing a dollar's worth of prenatal care can save $3 of postnatal care," said Mara Youdelman, director of the National Language Access Advocacy Project at the National Health Law Program in Washington, D.C. "It's much more costly to use Emergency Medicaid to pay for prematurity and low birth-weight babies and postnatal complications."

The research is published in the March 14 issue of the Journal of the American Medical Association, which has a series of articles on health care.

Undocumented immigrants are estimated to account for 29 percent of the total foreign-born population in the United States. Many "new growth" states that previously did not have large immigrant populations, such as North Carolina, are getting many of the newcomers. These "new growth" states may be less prepared to meet the health-care needs of the new arrivals, the study authors suggested.

In North Carolina, the total foreign-born population grew by 274 percent during the 1990s, and included about 300,000 undocumented immigrants by 2004. These immigrants face a host of barriers to accessing health care, not the least of which is federal law.

Undocumented immigrants and legal immigrants who have been in the United States less than five years are generally excluded from Medicaid benefits. But they can receive emergency medical care (known as Emergency Medicaid) if they are children, pregnant women, families with dependent children, or elderly or disabled.

For pregnant women, Emergency Medicaid funds cover labor but not routine prenatal care.

In their study, researchers at the University of North Carolina analyzed administrative claims data for Emergency Medicaid, which showed that 48,391 people in the state received emergency care between 2001 and 2004.

Within that group, 99 percent of patients were undocumented immigrants, 93 percent were Hispanic, 95 percent were female and 89 percent were between the ages of 18 and 40.

In addition, the data showed, about 82 percent of Emergency Medicaid spending in 2004 was for childbirth and pregnancy complications, which accounted for 91 percent of hospitalizations.

About one-third of the remaining funds were spent on "sudden-onset" problems, such as injuries and poisonings. (Hispanic immigrants account for a disproportionate number of workplace injuries and fatalities in the United States, and motor vehicle injuries are the leading cause of death among Hispanics in North Carolina). Large chunks also went to complications of chronic disease, such as kidney failure.

The study found that the largest spending increases occurred among undocumented immigrants who were elderly and disabled.

Spending on pregnant women increased by 22 percent during the study period, by 70 percent for families with dependent children, by 82 percent for disabled patients and by 98 percent for elderly patients.

Still, only a small proportion of the undocumented population seems to be using Emergency Medicaid. The 16,106 patients utilizing Emergency Medicaid in 2004 represented only 5 percent of the total estimated undocumented immigrant population of North Carolina. Emergency Medicaid was less than 1 percent of the total state Medicaid budget, the study authors said.

The study authors wrote: "The availability of affordable culturally and linguistically appropriate primary care, however, will be a critical determinant of both the effectiveness and cost efficacy of health care for immigrants in new-growth areas."

But without Emergency Medicaid, many medical institutions and poor people would be lost.

"We're very happy that Emergency Medicaid covers women, especially the ones who have childbirth, or we wouldn't have funding. We would be destitute," said Dr. Leo B. Twiggs, chairman of obstetrics and gynecology at the University of Miami Miller School of Medicine, and clinical service chief at Jackson Memorial Hospital. Jackson is the safety-net hospital for Florida's Miami/Dade county and serves many undocumented immigrants who give birth.

"It's the right thing to do," Twiggs said.

More information

Learn more about immigrant health-care options at the U.S. Department of Health and Human Services.

SOURCES: Mara Youdelman, J.D., LLM, director, National Language Access Advocacy Project, National Health Law Program, Washington, D.C.; Leo B. Twiggs, M.D., chairman of obstetrics and gynecology, University of Miami Miller School of Medicine, and clinical service chief, Jackson Memorial Hospital; March 14, 2007, Journal of the American Medical Association
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