Florida Medicaid Spending on Undocumented Immigrants Plummets After New Law

The amount of money that Florida’s Medicaid program spends to provide emergency health care to undocumented migrants has dropped significantly after Republican Gov. Ron DeSantis launched a multi-pronged crackdown on illegal immigration amid his unsuccessful primary bid for president.

DeSantis signed a law last year directing hospitals that accept Medicaid to ask patients about their immigration status when they seek treatment. While the law does not force patients to provide hospitals with an answer, immigrant rights groups feared the mandate would scare migrants away from seeking urgent medical attention. The DeSantis administration and other Florida Republicans say any marked decreases in spending are signs his immigration crackdown is working.

Florida’s Emergency Medical Assistance program for undocumented immigrants has seen a 54 percent drop in expenditures billed to Medicaid this year — with less than two months remaining in the fiscal year — since the state immigration law took effect, according to a POLITICO analysis. Thomas Kennedy of the Florida Immigrant Coalition said while there is no concrete evidence that the drop in Medicaid spending is a result of the law, which took effect in July 2023. there have been other signs of fallout.

“Obviously, there’s been somewhat of an exodus of migrants in Florida,” Kennedy said. “When this was all going through — we had warned about the exacerbated work[force] shortages and the distressed industries — we said this would be a bad idea.”

Federal law bars undocumented immigrants from Medicaid eligibility, even if they meet other requirements. But federal law also requires that states authorize limited Medicaid coverage for migrants facing a medical emergency, including dialysis, a pregnant woman delivering a baby or trauma.

Data provided to POLITICO by the Florida Agency for Health Care Administration and the U.S. Department of Health and Human Services show $148.4 million in state and federal Medicaid dollars went toward emergency coverage for immigrants in Florida in the year before the state’s new immigration law took effect. As of May 3, $67 million has gone toward emergency coverage this year. With two months left in the fiscal year that number will rise, but the state is still on track for a dramatic decrease in spending.

The spending drop represents a dramatic spike in the rate of decline. The AHCA data also shows Medicaid expenditures in the 12 months before the law took effect dropped a little more than 13 percent. Medicaid expenditures went from $171.4 million in 2022 to the $148.4 million from last year.

About half of the Emergency Medical Assistance spending goes toward pregnant women who were in labor, according to Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families — and he said a consequence of the state immigration law is that women may avoid the hospital when it’s time to give birth.

“Do we want the mothers of U.S. citizen babies avoiding the hospital when they unexpectedly go into labor?” Cuello wrote in an email. “This will have terrible long-term consequences for Florida.” When asked for comment, the governor’s office sent a statement from Alecia Collins, a spokesperson for AHCA. “While the state’s health care system is designed to serve and prioritize legal United States citizens, those with medical necessities will still be treated by a hospital,” she said.

The DeSantis administration has devoted millions of state budget dollars and other resources toward combating illegal immigration as part of an ongoing feud with the Biden administration over federal policy on the Mexican border. And next year’s $116.5 billion state budget includes a $557,882 line item for AHCA to expand a program created by the immigration law that monitors health care costs associated with undocumented immigrants.

In a separate statement, Collins wrote that Medicaid expenditures are only part of the financial burden that illegal immigration places on the state’s hospital system. AHCA’s budget surveillance program published a report in March that determined hospitals were left to cover more than $566 million in medical bills in the last six months of 2023 that patients who were undocumented did not pay.

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