http://www.boston.com/news/local/massachusetts/articles/2009/08/15/30000_immigrants_to_soon_lose_state_health_insurance/

Immigrants to soon lose state health insurance

Interim plan will cover ER and limited services

By Kay Lazar Globe Staff / August 15, 2009

Thirty thousand legal immigrants have begun receiving letters informing them that their state-subsidized health insurance is ending Aug. 31 and will be replaced by a patchwork system of care until Massachusetts officials can piece together a more comprehensive plan for the most critically ill.

"We know that this may be a hard time for you,'' states an accompanying note from Dr. JudyAnn Bigby, secretary of Health and Human Services. "We are committed to finding some way of covering at least some of the costs of your medical needs.''

Left unanswered is what sort of coverage this group will receive and ultimately what it will cost taxpayers.

The state's interim plan only covers emergencies and other limited services, leaving advocates worried about the welfare of these immigrants. Under the plan, immigrants will be receiving emergency care in hospitals and a limited number of other services through community centers under two state programs, the Health Safety Net and MassHealth Limited.

It is unlikely that they will be able to continue receiving coverage for routine or preventive care from their current doctors.

Advocates working with the administration said yesterday that state officials are concentrating on a longer-term plan that will use available funds to provide care for those who are the most seriously ill with cancer and chronic conditions such as diabetes and heart disease.

"Other people who need treatment or need to be diagnosed or get tests, we don't know what type of coverage they may be able to have,'' said Eva A. Millona, executive director of the Massachusetts Immigrant and Refugee Advocacy Coalition.

The federal government does not help pay for treating these 30,000 "special status'' immigrants, typically people who have been here less than five years and are not yet citizens, and thus they are more expensive for the state to insure. Many states have dropped coverage for this class of immigrants, but until now, Massachusetts had continued to provide comprehensive care.

Facing huge budget gaps, lawmakers and Governor Deval Patrick's administration battled much of the spring over coverage for immigrants, with Patrick insisting that these tax-paying residents were entitled to full care. Last month, the Legislature approved $40 million for immigrants' care, $90 million less than the governor requested in his original proposal. The administration then said that $40 million was not "sufficient to maintain meaningful coverage or to develop a scaled-back program.''

Yesterday, Patrick administration spokeswoman Cyndi Roy said in an e-mailed statement that the administration is "still determining how best to use the $40 million.'' She declined to elaborate.

When state lawmakers approved the $40 million, they required state officials to come up with a plan for using it. If they were unable to, the bill said, the money could be transferred to the Health Safety Net program, which reimburses hospitals and community centers for care given to the uninsured poor. The Legislature also stipulated that the Patrick administration could not spend any more than $40 million for the entire group of immigrants through next June.

Brian Rosman, research director for the consumer group Health Care for All, said yesterday that $40 million is not nearly enough to pay for the coverage outlined in the letters to immigrants, and that the administration will probably need to seek additional money from the Legislature by the spring.

Analysts have warned that next year's state budget may need to be even tighter than the current spending plan, because the current budget relies on one-time federal stimulus money and state reserves.

Part of the state's interim coverage plan for this group relies on emergency care delivered through hospitals under the Health Safety Net program. Under law, hospitals cannot turn away patients seeking emergency care, and Rosman said the hospitals' tab could grow hefty.

"If demand for services exceeds money available, the law provides for making proportional cuts to all hospitals,'' he said. "For hospitals on the front line, that means being underpaid for their services, and that gets made up in the long run by higher insurance costs for everyone else.''

Kay Lazar can be reached at klazar@globe.com.