Florida hospitals get extra week to report care costs for undocumented immigrants

Liz Freeman
Naples Daily News

Florida hospitals have a new deadline of May 31 to comply with a state order to tally and report how much in taxpayer dollars has been spent caring for undocumented immigrants.

An original deadline was May 23 but was extended at the request of some hospitals, including the NCH Healthcare System in Collier County.

Gov. Ron DeSantis signed an executive order in September directing several state agencies to gather data about undocumented immigrants coming into the state after crossing the southwest U.S. border illegally and services they are being provided.

Gov. Ron DeSantis speaks Oct. 15 at the Collier County Public Schools building in Naples, On Friday, DeSantis rolled out a series of proposals for the upcoming 2022 legislative session aimed at the border policies of President Joe Biden.

The directive was signed the same day the state filed a lawsuit against the Biden administration for not enforcing immigration laws. The governor appointed a state “public safety czar” in charge of making sure directives under the executive order are carried out.

Two of the agencies that must report data are the state Agency for Health Care Administration which has oversight over hospitals and Medicaid, and the state Department of Children and Families which oversees family services and foster care.

DCF has been told to not renew the licenses of any foster care homes that apply to house unaccompanied children under the federal Office of Refugee Resettlement where “evidence of need” is not shown, according to the order.

Texas Department of Public Safety special agents monitor four undocumented immigrants from Honduras who were caught on private property. Hospitals in Florida have to comply by May 31 with a state order to tally and report how much in taxpayer dollars has been spent caring for undocumented immigrants.

How are hospitals responding?

In a May 5 letter to the Florida Hospital Association, the state health care agency advised hospitals they had until May 23 to submit reports for how much in medical care they provided to undocumented immigrants in fiscal year 2021 and each year thereafter.

The hospital association represents roughly 200 hospitals out of the 325 in Florida.

“As illegal aliens continue to cross the southern border unchecked in record numbers, hardworking Floridians pay the price, footing the bill for their medical care,” Simone Marstiller, secretary of the state agency, said in the letter.

Secretary of Agency for Healthcare Administration Simone Marstiller speaks Monday, Feb. 7, 2022 at the Jacksonville River City Downtown Hotel. A panel discussion about HIV/AIDS prevention and care was hosted by Clear Health Alliance and headlined by NBA hall of famer Earvin "Magic" Johnson. [Corey Perrine/Florida Times-Union]

The data must distinguish the source of all costs, including uncollected debt calculations for the care of the undocumented immigrants.

Marstiller reminded the state hospital association that it had produced a report in 2009 that examined how 57 hospitals had incurred $40 million in unpaid bills in one calendar year for the care of undocumented immigrants.

“Given that (the hospital association) has performed similar calculations in the past, I would ask that you ensure your member hospitals are aware of these requirements and provide technical assistance in completing the data request,” Marstiller said.

The state agency intends to make the information public on its website so Florida residents can see the financial impact of paying for services to undocumented immigrants, the letter said.

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What do SWFL hospitals say?

Hospitals in Southwest Florida say they are working to comply with the executive order.

NCH, in a recent call with the hospital association and other hospitals, requested the association ask for a time extension, according to NCH general counsel Matt Heinle.

“The (state agency) new reporting requirement is extremely difficult because we have no way of knowing each patient’s nationality or legal status under U.S. immigration laws,” he said in an email.

The hospital association notified hospitals that the state agreed to an extension until May 31, according to a May 18 email from Mary Mayhew, executive director of the hospital association. Mayhew previously was the secretary of the state health care agency under DeSantis before going to the state hospital association.

Florida Hospital Association President Mary Mayhew speaks during an event held to reveal Bethel Missionary Baptist Church's new Mobile Medical Unit at the church Monday, May 10, 2021.

In addition, Heinle said NCH does not ask about immigration status when patients are seeking medical care in the emergency room, he said.

Patients’ immigration status may surface when hospital staff is gathering insurance information or in assisting patients to receive further care in a nursing home or another setting, he said.

“(NCH) is a charitable organization that provides care to everyone, regardless of financial and insurance status,” he said. “We comply with all laws.”

Lee Health, the publicly-operated hospital system in Lee County and one of the largest in the state, is working on the data reporting, spokesman Jonathon Little said.

“Lee Health is working closely with the Florida Hospital Association to understand the Agency for Health Care Administration’s expectations for hospitals and is working to gather the requested data,” he said in an email.

Physicians Regional Healthcare System, also in Collier, referred inquiries to the state hospital association.

What does the hospital group say?

Several hospitals have already reported their data to the state agency, according to Timothy Jacques, a spokesman for the state hospital association. He did not share how many.

Under the federal Emergency Medical Treatment and Labor Act, hospitals are required to treat and stabilize anyone coming into emergency rooms regardless of ability to pay.

“Once stabilized, hospitals are responsible for collecting identifying information that allows them to report and request reimbursement appropriately, Jacques said in an email.

The governor’s executive order directs the state agency to use all lawful means to determine the amount of state and local money spent on the health care of undocumented immigrants and coordinate with DCF and the Department of Health on collecting the data.