Advocates: If hospitals ask about immigration status, don't answer

In a patchwork of ways, medical officials across Florida have started complying with the state's new immigration law which requires hospitals that accept Medicaid to ask admitted patients their citizenship status.

The law leaves room for discretion for health care administrators and allows hospitals to determine how much detail to include after "What is your citizenship status?"

A little over one week after the start of SB 1718, Florida hospitals are offering either an actual citizenship question form, electronic or paper, or asking patients verbally during the intake process, said Justin Senior, CEO of the Safety Net Hospital Alliance of Florida.

The law, a priority of Florida Gov. Ron DeSantis that's been dubbed one of the strictest immigration laws in the country, states hospitals that participate in Medicaid must have a provision on its admissions form to "indicate whether the patient is a United States citizen or lawfully present in the United States or is not lawfully present in the United States," with a disclaimer that reads the response will not impact a patient's care or result in a report to immigration authorities.

GOP lawmakers and supporters of the law say taxpayers shouldn't have to foot the bill for undocumented people's medical care.

"We can't touch illegal immigration enforcement, but what we can do is join with other states to take away the inducements and the incentives," said bill sponsor Sen. Blaise Ingoglia during a committee hearing.

Critics, meanwhile, say the question will cause "undue harm and fear" for migrants seeking care.

"Instead of creating new barriers and perpetuating the suffering of our undocumented patients, we should be working to expand access to healthcare for all patients, regardless of their immigration status," wrote Dr. Olveen Carrasquillo is a Professor at the University of Miami Miller School of Medicine in a column published in the Tallahassee Democrat.

This is the second time, DeSantis has tried to quantify the cost of care in the state for undocumented people.

In September 2021, Gov. Ron DeSantis signed an executive order requiring the Florida Agency for Health Care Administration to begin collecting data from hospitals on the amount of money spent on caring for undocumented immigrants. But hospitals struggled to meet the demand because they didn't ask patients if they were citizens.

How hospitals are approaching the new law

Now they must, and according to the Florida Hospital Association, the law says the question can lead to the following answers: United States citizen, non-citizen that is lawfully in the U.S., not lawfully in the U.S. or decline to answer.

But a hospital can include anything else they want on the form.

"Hospitals have discretion regarding the exact language and level of detail included in the required disclaimers," said Julie Hauser, an FHA spokesperson.

AdventHealth, which has hospitals in Orlando and Ocala, includes in its citizenship status acknowledgement the following: "You are not required to produce any documents or papers to verify your answers to these questions."

Also included, in bold and underlined, "No specific information that will identify you will be included in this report. The information is de-identified."

At the bottom, a patient is required to sign the form, acknowledging that they have read and understand it "so we can ask you questions about your citizenship status."

Already patients are asked a number of questions when admitted, ranging from pre-existing conditions to whether they drink, smoke or do drugs.

Senior, who represents Florida's safety net hospitals, said if a patient wants more information about the added citizenship question on the electronic intake form, it leads to a link to the Florida statute. If the question is asked verbally, a script pops up that prompts the health care administrator to read the law.

Safety net hospitals provide care to low-income, uninsured and vulnerable populations and account for more than half of Florida's trauma center admissions. In Florida, safety net hospitals include Johns Hopkins All Children's Hospital, Broward Health, Orlando Health, Tampa General Hospital and Jackson Health System, among others.

HCA Florida Healthcare, which operates 50 hospitals in the state, released the following statement: "Our priority is to provide exceptional and compassionate care to all of our patients. Any time the legal, legislative or regulatory landscape changes, our responsibility is to be in compliance with applicable state and federal laws and regulations."

Tallahassee Memorial HealthCare will be asking the question via an electronic admissions process, said spokesperson Rebeccah Lutz. The hospital is currently working on being in compliance with the new law, she said.

Advocates stress that you don't have to answer the question

Immigration attorney Kelly Dominguez said that while the hospitals are required to ask a patient about their citizenship status, patients are not required to answer the question.

"The law is still very fresh," said Dominguez, a partner with Mubarak Law out of Orlando. "At this time, what I tell my clients is they do not have to provide a response if they don't feel comfortable providing a response to that answer, and just leaving it blank."

Yesica Ramirez, an organizer with the Farmworker Association of Florida who is based in Apopka, said immigrants she works with who have gone to the hospital after July 1 told her they have yet to see the citizenship form. They've filled out other information, like race and medical history, but not citizenship status.

She's advising everyone who is admitted to the hospital, regardless of citizenship status, to refuse to answer the citizenship question.

"We want to make it harder for them to indicate who is undocumented," she said.

As DeSantis takes hard-line on immigration, advocates 'on alert'

DeSantis, who is vying for the Republican nominee for president, is campaigning on a hard-line immigration platform that would restrict asylum claims, end birthright citizenship and finish Trump's border wall. Recently, he sent Florida National Guard and law enforcement to Texas to help police the border and was criticized for flying migrants to Sacramento and Martha's Vineyard.

The Florida governor has stated the citizenship form requirement for hospitals is to help the state with data to track Medicaid spending on undocumented immigrants. Hospitals will have to turn in a quarterly report with the number of undocumented patients who were admitted or who visited the emergency department.

Florida Medicaid reimburses hospitals for emergency services, including labor, delivery and dialysis, but will not cover treatment after the emergency is over, according to Florida's Medicaid policy.

"We were able to identify some, we think that there's a lot more, and the public deserves an honest accounting of how much this is costing us in terms of services, and health care is probably number one," he said in May when he signed SB 1718.

Immigrant advocates say the hospital admissions form will discourage people from seeking health care. Ramirez said immigrants are afraid and there are rumors that a hospital will call immigration — that isn't true.

"We're on alert as to what's going in the community," Ramirez said. "There's the risk that a person might encounter someone racist and not know their rights and stay silent."