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Delivering dual benefits

Medi-Cal spends about $400 million a year on birth-related care for illegal immigrants. Private hospitals gain.

December 23, 2006|Evelyn Larrubia | Times Staff Writer

Sandra Andrade lay in her hospital bed, overcome with anxiety about her newborn son.

All through her pregnancy, she had worried. The placenta was blocking her birth canal and growing into other organs. She knew she needed a Cesarean: If she went into labor, she might bleed to death.

Now her boy was in intensive care at Women's and Children's Hospital at Los Angeles County USC Medical Center. With his future -- and her own recovery -- on her mind, Andrade, 36, was relieved to be spared at least one worry: Who would pay for their care.

She'd been without private insurance since the premiums became too costly. But a friend assured her that, even as an illegal immigrant from Colombia, she would qualify for Medi-Cal, the state and federal health insurance program for the poor.

Andrade, a clothing exporter, is one of more than 100,000 undocumented women each year who bear children in California with expenses paid by Medi-Cal, according to state reports. They now account for about one in five births.

Regardless of their parents' status, the children are American citizens by law.

Many illegal immigrants who might otherwise shy away from government services view care associated with childbirth as something they can safely seek, a protected right.

"I wasn't afraid at all," said Andrade, who came to the United States with her daughters on a tourist visa and stayed here with her boyfriend after it expired. "I'd always heard that pregnant women are treated well here."

California long has been one of the more generous states in offering such benefits, covering everything from pregnancy tests to postpartum checkups for impoverished illegal immigrants.

'Birthright' citizenship

Such births and associated expenses account for more than $400 million of the nearly $1 billion that the program spends each year on healthcare for illegal immigrants in California, documents and reports show. Only about a dozen other states extend similar benefits to illegal immigrants, according to health and immigrant rights groups.

Although it has not so far figured prominently in the national discussion of immigration reform, a debate is simmering about the costs -- and the rights -- of illegal immigrants' American-born children.

Some advocates for immigration control want to abolish automatic or "birthright" citizenship for babies born to undocumented women in the United States. They consider it just the first in an unacceptably long line of public benefits flowing to children who were born here only because their mothers broke the law.

"I think most Americans think that -- while they certainly don't want to do anything to harm children -- you cannot have a policy that says anybody in the world come here and have a baby and we have a new American," said Ira Mehlman, a spokesman for the Federation of American Immigration Reform, an immigration control group based in Washington, D.C.

One of the most controversial aspects of coverage has been prenatal care. Labor and delivery long have been considered emergencies, entitled to some federal reimbursement. But federal officials have balked at covering prenatal care since at least the 1980s. (Generally, the state and federal governments share the cost of Medicaid programs -- called Medi-Cal in California.)

In 1989, California passed a law guaranteeing prenatal care to all impoverished women, with the state footing the bill. Last year, it began to tap federal funds dedicated to healthcare for working families, under the theory that the fetus would ultimately be an American child. Some other states have done the same.

Those who favor such coverage say it's cheaper to pay for prenatal care than risk complications that could saddle the U.S. government with staggering medical bills.

An often-cited 1985 study by the Institute of Medicine found that every dollar spent on prenatal care saved more than $3 in medical costs by reducing the number of underweight babies and other problems.

'A serious risk'

"Without prenatal care, there's a serious risk that a child will be born with severe disabilities," said Lucy Quacinella, a lobbyist for the Los Angeles-based social service nonprofit group Maternal and Child Health Access. "The cost of caring for that child over a lifetime is astronomical when you compare the cost of having provided the prenatal care for the mother."

Investing in pregnant illegal immigrants and their children is no small undertaking.

Births and prenatal care are the biggest single outlay by Medi-Cal for illegal immigrants' healthcare, with the rest going for various other emergency treatments, limited breast and cervical cancer treatment, abortions and some nursing home care, according to the state.

In Los Angeles County's public and private hospitals, undocumented women accounted for 41,240 Medi-Cal births in 2004, roughly half the deliveries covered by the public program.

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