New Florida immigration legislation that is expected to be signed within weeks by Gov. Ron DeSantis would require hospitals to ask patients about their immigration status and report that information to the state — a move that raises ethical and legal concerns for physicians and hospitals.
Last month, sister bills HB 1617 and SB 1718 were introduced in Florida's House of Representatives and Senate. They require hospitals that accept Medicaid to collect patients' immigration status during admission or registration. The request for information must also include a disclaimer that the patients' responses will not affect their care or be reported to immigration authorities. Patients' names would not be disclosed to the state.
The bills would take effect July 1 if signed by DeSantis and could place physicians in a difficult position. The American Medical Association opposes documentation of immigration status in the health record and proof of citizenship as factors in receiving healthcare.
Any policies that could potentially delay access to timely care are concerning, Damian Caraballo, MD, president of the Florida College of Emergency Physicians, told Medscape Medical News. However, under the federal Emergency Medical Treatment and Active Labor Act, "emergency physicians will continue to see anyone who seeks emergency care in emergency departments across Florida 24 hours a day, 7 days a week," he said.
The sweeping legislation appears to be an extension of an executive order DeSantis issued in 2021 and represents the state's latest attempt to stem what it describes as high costs associated with providing healthcare services to undocumented immigrants.
The executive order required managed care plans and hospitals to report any Medicaid or other governmental expenditures incurred for the healthcare of noncitizens, including emergency care, beginning with fiscal year 2021 and continuing in each subsequent year.
According to a state report, undocumented immigrants accounted for more than 111,000 encounters and 23,000 hospital admissions in fiscal year 2021, and the cost of care exceeded $312 million. Facilities were reimbursed for about one third of the cost. Local and state funding contributed $700,000 and $105 million, respectively, per state figures.
The American Civil Liberties Union of Florida opposes the legislative efforts. Legal scholars argue that immigration status should be protected under HIPAA and should not be released to federal or state authorities "without valid exception." A law requiring disclosure could circumvent those privacy protections.
The legislation mandates that hospitals submit a quarterly report to the Florida Agency for Health Care Administration (AHCA), the organization that oversees the state's Medicaid program and the licensure of healthcare facilities. The report must include the number of hospital admissions or visits from the previous quarter and must indicate the number of patients who are lawfully present in the US or are US citizens, the number who are not lawfully present, and the number who declined to answer.
AHCA must also submit an annual report of the findings to DeSantis and the state legislature that outlines the costs of uncompensated care for noncitizens and the impact of those costs on the hospital's funding and capacity to provide other public services.
While the bills grant AHCA the authority to adopt rules relating to how hospitals collect information and format reports, they prohibit the disclosure of patient names to the agency. Despite this safeguard, "good luck convincing patients to trust hospitals that collect that sort of clinically irrelevant information," said one r/medicine subreddit user.
Alison Yager, JD, executive director of the Florida Health Justice Project, told Medscape Medical News the bills would likely have a "chilling effect" on healthcare access and would exacerbate healthcare disparities.
"Any time there is the specter of immigration enforcement or an impact on an immigration application, people will opt to stay home instead of going to the hospital," she said. "I don't think it's an exaggeration to say people will die as a result."
The latest bills do not indicate whether hospitals can opt out of the reporting requirements or the penalties for noncompliance. In addition to recording immigration status, the bills would make transporting noncitizens into or within the state a felony and would have ramifications for physicians and other healthcare professionals offering such services.
"These bills are going to dissuade people who are multiply marginalized from seeking healthcare" and will complicate treatment when they do access care, said Laura Kallus, chief executive officer of Caridad Center, the largest free health clinic in Florida.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.
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Cite this: Hospitals Will Record Patients' Immigration Status Under New Florida Law - Medscape - Apr 25, 2023.