Hospitals throughout Florida are challenging a state rule that limits payments to treat undocumented immigrants.
The hospitals say the Agency for Health Care Administration made the rule without following the proper procedures and unfairly wants them to reimburse the state for some of the Medicaid payments used to treat immigrants who aren’t legally in the United States.
At issue is a technical dispute over how much Medicaid pays for emergency services and when an emergency patient turns into a “stable” patient still in need of care. AHCA’s position is that Medicaid covers emergency care for undocumented patients, but not the ongoing treatment needed to keep the patient stable.
The rule could save taxpayers "millions and millions of dollars," but it would burden large hospital systems that provide loads of charity care, said Joanne Erde, an attorney representing the hospitals.
"What the state is saying is: ‘We don’t care if the patient is in the hospital or not or if the services are medically necessary, we’re not going to pay for anything beyond the point of stabilization’ — whatever that is,” Erde said. “And they’re applying it retroactively, back to 2005, in order to get money back from the hospitals.”
Erde’s clients filed a challenge with the Division of Administrative Hearings on Wednesday. They’re not specifically challenging the rule affecting Medicaid reimbursements, but the fact that it was implemented without public hearings.
AHCA said it never changed its policies, but simply conducted an audit to enforce what was already on the books.
“Our policy has not changed,” said AHCA spokesperson Shelisha Coleman. “We did an audit that raised suspicion that the hospitals were treating illegal aliens for emergencies and continuing treatment after the emergency had stabilized.”
AHCA did not provide data on how much money would be saved from the audit.