RE: uncompensated care

October 15, 2002

Here is the article that references in her message below. Lighthall, Ph.D.Research CoordinatorRelational Culture Institute1069 N. FultonFresno, CA 93728530 304-0038 (mobile)david@...

October 14, 2002

States Forfeit Unspent U.S. Money for Child Health InsuranceBy ROBERT PEAR

ASHINGTON, Oct. 13 — Large amounts of federal money intended to provide health insurance to children are going unused, federal officials say, even though 8.5 million children are uninsured.

On Oct. 1, states lost $1.2 billion that had been appropriated by Congress to provide health coverage for low-income children. The money, unclaimed after four years, reverted to the Treasury and can now be used for other purposes — anything, including law enforcement, military pay, farm subsidies or the fight against terrorism.

A. Scully, administrator of the federal Centers for Medicare and Medicaid Services, said he hoped that Congress would pass legislation to restore the money to the Children's Health Insurance Program.

"States should find some way to use that money to cover the uninsured," Mr. Scully said. "If you don't use it, you lose it."

President Bush foresaw the problem. In his budget, issued in February, he asked Congress to let states keep the money until 2006. Several senators have introduced bills to extend the deadline for use of the money, while redirecting some of it to states most likely to spend it.

Congress has not taken action on any of the proposals, even though lawmakers often lament that millions of children are uninsured according to the Census Bureau.

State officials, struggling with severe budget problems, are pleading with Congress to extend the deadline for them to use the federal money.

Gov. L. O'Bannon of Indiana, a Democrat, said he and other governors feared that "if this money is lost, the federal government's growing budget deficit will make it difficult to recover it at a later date."

Cooke, director of the Children's Health Insurance Program in Texas, which provides coverage for 510,000 youngsters, said: "It would be most unfortunate if the money stays in the federal Treasury. There is still lots of unmet need."

The Bush administration estimates that states will lose $1.6 billion more next year if Congress takes no action, in addition to the $1.2 billion lost in the current year.

The recession has increased the number of people without insurance and cut revenue collections in most states, which need every dollar of federal aid they can find.

The Children's Health Insurance Program, created in 1997 with bipartisan support, has been extremely popular and is widely viewed as a success. More than four million youngsters are enrolled. Many come from working families with incomes too high to qualify for Medicaid, but too low to afford private health insurance.

The Bush administration and advocates for children estimate that enrollment in the child health program will drop by 600,000 if Congress does nothing to restore federal money.

Twenty-five states forfeited money at the beginning of this month. New York lost more than any other state, $397 million, about one-third of the total.

Gov. E. Pataki of New York, a Republican, has strongly supported the program, which serves more than 500,000 children in the state. New York spent all its initial allotments and therefore received unspent money from other states in each of the last two years, but New York could not spend it all.

Indiana and North Carolina each lost $100 million of federal money on Oct. 1. South Carolina lost nearly $90 million. Arkansas lost $44 million, and Washington State lost $35 million.

While the purpose of the program is straightforward, the bookkeeping is complex. States have three years to use the money they receive for a particular year. If a state fails to use its full allotment in the three-year period, the federal government redistributes some of the unused money to other states that spent all the money they got. Any money that remains unused must eventually be returned to the Treasury.

The money that reverted to the Treasury on Oct. 1 was originally earmarked for 1998 and 1999.

Why does money remain unspent? In many states, the program got off to a slow start.

"States could not spend the money fast enough," said Mr. Cooke, the director of the Texas program.

Texas received an allotment of $502.8 million for the fiscal year 2000, Mr. Cooke said, but $285 million remains unspent and would, under current law, be redistributed to other states.

Jana L. , the program director in Georgia, said her state received more money than it could use in the early years and would have less than it needs in the next few years. That kind of mismatch is common.

Several members of Congress have tried to restore money for the children's health program, but they have been stymied by disagreements over how to divide the money among various states.

President Bush's proposal would allow states to keep the money they received for 1998, 1999 and 2000. Senators D. Rockefeller IV, Democrat of West Virginia, and Lincoln Chafee, Republican of Rhode Island, want to redirect a large share of the unused money to states with greater needs.

Edwin C. Park, a policy analyst at the Center on Budget and Policy Priorities, a liberal research institute, said the president's proposal "leaves large sums in states that cannot use them, rather than redistributing money to other states that will need it to avert sharp cutbacks in their programs."

Governor Pataki placed the onus on Congress, particularly the New York senators, E. Schumer and Hillary Rodham Clinton, both Democrats.

R. Hinckley, a spokesman for Mr. Pataki, said, "We really expect our senators to ensure that New York's children are not left behind."

Mrs. Clinton said it was imperative for Congress to act this year. But she added, "I am very concerned that the administration's proposal would tie up money in states that can't spend it, while children in other states like New York, where we spend our full allotment, will lose coverage for lack of funds."

Copyright The New York Times Company | Permissions | Privacy Policy -----Original Message-----From: [mailto:sdavis@...]Sent: Tuesday, October 15, 2002 8:36 AM Subject: [ ] uncompensated careAs and Tina have said, uncompensated care is a big issue, not oneexclusively related to immigrant workers, but one in which immigrantworkers play a big role. Undocumented immigrants frequently rely onhospitals when they are in great need of medical care. In life-threateningsituations, undocumented immigrants are eligible for Emergency Medicaid.The Welfare Reform law, which conditioned regular Medicaid on being a"qualified" immigrant, did not restrict access to Emergency Medicaid on thebasis of immigration status. Emergency Medicaid, however, is limited tocare needed in life-threatening situations. This is a great limitation.In the absence of eligibility of Medicaid or CHIP, uninsured people --whether they are legal or not -- end up using hospitals and creating billsfor uncompensated care.The problem of uncompensated care is in no way limited to the borderregion. In early September, an article in the NY Times discussed theproblem of uncompensated care nationally and it was far greater than thesum listed for the border. This is a problem requiring a national solution.One other thing to keep in mind is that in times of deficit, at both thenational and state levels, new federal programs are probably unlikely.Indeed, yesterday's NY Times reported that about $1 billion in state SCHIPfunds has to be returned to the federal treasury, based on a requirement ofthe SCHIP program which gave the states 3 years to use the funds theyreceived or lose them. Efforts are also underway to try to restore thesefunds to the states because their need for the money will grow as morechildren are enrolled in the program. However, federal action to restorethis money is not extremely likely because the Congress is about to go homefor the election period -- and when it returns it has to passappropriations bills for just about every government agency. Expansion of a Medicaid or SCHIP - type program for low income adults wouldgo a long way to reducing the total costs of uncompensated care.

October 23, 2002

Iam really woundering about if there is any funding for immigrant students who

are excelling in school and don't have legal documentation processed,they don't

know how to go about that and fear going to apply at immigration?What are

reccomended actions to take for them? Gracias Norma translator

--------------Original Message-------------

From: keith.bletzer@...

Date: Tue, 22 Oct 2002 07:12:55 -0700

Subject: [ ] uncompensated care

>Further comments to the discussion of uncompensated care by Tina, ,

> and .

>

>Each contributor to this discussion hit the principal nails, and hit them

>firmly. The report on which most of the AMA article was based originally

>was completed for border counties of four states (interestingly, one of the

>quoted physicians in the AMA article was from Maricopa County [Phoenix]

>which is not a border county). First, the Border Counties Coalition report

>attributes no more than 23% of uncompensated emergency services cost to

>undocumented immigrants. Who is using the other 77%? Any group(s) in

>numbers? points that uncompensated care is not just a dilemma for

>border counties/states, and not just about immigrants. At a time when

>budgets are dismal, separating the vulnerable from the rest makes a remedy

>possible, at the expense of the vulnerable.

>

> and are correct about the relation between the uninsured and

>usage of emergency services. Arizona ranks among the nation's highest in

>number of uninsured. The uninsured often use emergency services.

>Interestingly, none of the border states were among those having difficulty

>using funds from the Children's Health Insurance Program ('s article

>provided by ).

>

>The Coalition report compares border counties with non-border counties from

>the same states. Hence, there is the second factor. Arizona and the three

>border states are part of the Sunbelt; they attract people from across the

>country from all income levels, low and high. Immigrants join internal

>migrants and the state's poor in making use of emergency health services.

>The researcher in me wants to know if there are patterns in the

>uncompensated care. Are certain categories experiencing repeated use of

>emergency services? (Eg, single parents with pre-school children,

>particular age groups) Are certain time periods more represented? (Eg,

>weekends, late afternoon, Mondays) Are certain problems over-represented?

>(Eg, lacerations, poisoning, gastrointestinal complaints, or flu symptoms)

>

>Good discussion, overall. Thanks.

>

> V. Bletzer

>

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>

October 23, 2002

IS it possible for migrant un documented students high school and college to

recieve funding for college from any non government ,private organizations?What

organizations could help with funding and the process of filing to recieve

documentation of citizenship?Gracias Norma translator