A large majority of the Emergency Medicaid expenditures in North Carolina are for childbirth and complications of pregnancy for patients who are undocumented immigrants, although spending for undocumented elderly and disabled patients is increasing at a faster rate, according to a study in the March 14 issue of JAMA, a theme issue on access to care.
C. Annette DuBard, M.D., M.P.H., of the University of North Carolina, Chapel Hill, presented the results of the study today at a JAMA media briefing on access to care at the National Press Club.
A steady increase in the number of foreign-born adults and children living in the United States has fueled debate about the financial burden new immigrants may place on publicly funded health care, but relatively little is known about the health status and health services use of this population, according to background information in the article. Undocumented immigrants constitute an increasing proportion of newly arrived individuals, with numbers now estimated to exceed 10 million, or 29 percent of the total U.S. foreign-born population.
Federal law generally excludes undocumented immigrants, as well as legal immigrants who have been in the United States less than 5 years, from Medicaid eligibility. These individuals can, however, receive Medicaid coverage for emergency medical services (Emergency Medicaid) if they belong to a Medicaid-eligible category, such as children, pregnant women, families with dependent children, elderly or disabled individuals, and if they meet state income and residency requirements.
Dr. DuBard and Mark Wayne Massing, M.D., M.P.H., Ph.D., of the Carolinas Center for Medical Excellence, Cary, N.C., analyzed administrative claims data related to the Emergency Medicaid program in North Carolina from 2001 through 2004 to determine the sociodemographic characteristics of the population served, expenditures including trends over time, and the types of diagnoses by cost and by frequency of hospitalization.
The researchers found that a total of 48,391 individuals received Emergency Medicaid coverage between 2001 and 2004. Among these patients, 99 percent were undocumented, 93 percent were Hispanic, 95 percent were female, and 89 percent were in the 18- to 40-year age group. Emergency Medicaid spending increased by 28 percent during this period. Approximately 82 percent of Emergency Medicaid spending in 2004 was for childbirth and complications of pregnancy, and these accounted for 91 percent of hospitalizations. Injury and poisoning accounted for approximately one-third of the remaining spending. While spending for pregnant women increased by 22 percent during the 4-year period, spending increased by 70 percent for families with dependent children, 82 percent for disabled patients, and 98 percent for elderly patients.
"The trends in use and expenditures under North Carolina's Emergency Medicaid program described in this study provide important insights into the health care needs of immigrants in new-growth states, and reveal the limited scope of services for which publicly funded reimbursement is applicable under current federal law," the authors write.
"Medicaid spending for emergency care of recent and undocumented immigrants, although a small proportion of the total Medicaid budget, is increasing rapidly in this new immigrant growth state. Emergency Medicaid is predominantly a program for childbirth coverage, although use and spending are shifting toward non-pregnant adults, particularly those who are elderly and disabled. Increased access to comprehensive contraceptive and prenatal care, injury prevention initiatives, preventive care, and chronic disease management may make better use of the public health care dollar by improving the health status of this population and alleviating demand for costly emergency care."
(JAMA. 2007;297:1085-1092. Available pre-embargo to the media at www.jamamedia.org)
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