Colorado to pay for outpatient dialysis care for undocumented immigrants
Friday, January 25, 2019
Posted by: Diane Berg
Colorado’s Medicaid program will cover the cost of outpatient dialysis for undocumented immigrants starting Feb. 1.
The Colorado Department of Health Care Financing and Policy had previously planned to implement the coverage last Sept. 1 but postponed the change due to concerns about “operational implications” and wanting to further review stakeholder input, according to a notice placed on the department’s website.
The new coverage is based on the department’s decision to classify ESRD as an emergency medical condition defined as an illness “that places a patient’s health in serious jeopardy, could result in serious impairment to bodily functions, or could cause serious dysfunction of any bodily organ or part,” the department said in a frequently asked questions document released about the new policy.
The revised definition affects all recipients of Emergency Medicaid Services, which cover emergency-only medical treatment for anyone who does not meet the citizenship requirement of Medicaid, but otherwise meets all other eligibility criteria. Under the revised definition of ESRD, recipients of Emergency Medicaid who have a diagnosis of kidney failure, can receive services in the inpatient setting — as they have previously — or at an independent free-standing dialysis center. The coverage does not include a kidney transplant or home dialysis.
Like other states, Colorado’s Medicaid program complies with the Emergency Medical Treatment and Labor Act. The law passed in 1986 compels hospitals with emergency rooms to care for anyone whose life is in imminent danger, regardless of their citizenship status or if they can pay for their care. However, dialysis was not defined by the state as an emergency medical condition, and so Medicaid only paid for one emergency dialysis session a week. The difficulties and deteriorating health of undocumented patients with ESRD living in Colorado with limited access to care was featured in a CNN documentary last August. Lily Cervantes, MD, a hospitalist with Denver Health who was profiled in the documentary, wrote an article, published in the February 2018 issue of the American Journal of Kidney Diseases, arguing that the country needed to create a national policy on providing ESRD care to undocumented residents.
“Compared to standard hemodialysis, emergency-only hemodialysis has a higher death rate and is also nearly four-fold more costly due to a greater number of emergency department visits and increased medicine ward and intensive care unit stays,” she and co-authors wrote. “Emergency-only hemodialysis should raise serious ethical concerns due to the physical and psychological suffering associated with this practice.” –by Mark E. Neumann
Source: Healio/Nephrology News and Issues