Washington, September 22, 2007 - The federal government has given instructions to New York State health department that chemotherapy being a costly affair for illegal immigrants under a government-financed program for emergency medical care, does not qualify for coverage.

This decision has set the stage for a battle between the state and federal governments over how medical emergencies are defined.

The change comes amid a fierce national debate on providing medical care to immigrants, with New York State officials and critics saying this latest move is one more indication of the Bush administration’s efforts to exclude the uninsured from public health services.

State officials in New York and other states have found themselves caught in the middle. The New York dispute, focusing on illegal immigrants with cancer a marginal group of unknown size among the more than 500,000 people living in New York illegally - has become a flash point for health officials and advocates for immigrants in recent weeks.

Under a limited provision of Medicaid,  the national health program for the poor, the federal government permits emergency coverage for illegal immigrants and other non citizens. But the Bush administration has been more closely scrutinizing and increasingly denying state claims for federal payment for some emergency services, Medicaid experts said.

Last month, federal officials, concluding an audit that began in 2004 and was not challenged by the state until now, told New York State that they would no longer provide matching funds for chemotherapy under the emergency program.

Yesterday, state officials sent a letter to the federal Medicaid agency protesting the change, saying that doctors, not the federal government, should determine when chemotherapy is needed.

Federal health officials declined to discuss chemotherapy or the New York claims. But Dennis Smith, director of the Center for Medicaid and State Operations at the federal Centers for Medicare and Medicaid Services, said in a statement, “Longstanding interpretations by the agency have been that emergency Medicaid benefits are to cover emergencies.”

The federal statute that defines an emergency under Medicaid makes it clear that routine care for illegal immigrants and nonresidents, including foreign students and visitors, is not covered. But the only procedures it specifically excludes from reimbursement are organ transplants, leaving to the states the task of further defining an emergency. States and courts have grappled with the question for years, yielding no clear definition. 

Some states have maintained that any time a patient is able to schedule an appointment — as opposed to showing up at an emergency room — the condition would not be considered an emergency. Others, including New York, have defined an emergency as any condition that could become an emergency or lead to death without treatment.

“There are clearly situations that we consider emergencies where we need to give people chemotherapy,” Richard F. Daines, the New York State health commissioner, said in an interview late yesterday. “To say they don’t qualify is self-defeating in that those situations will eventually become emergencies.”

Dr. Daines said that for every effort in the state to use Medicaid “creatively” to cover the uninsured, “the Bush administration, at every chance, is pushing it back.”

Full Story: http://www.nytimes.com/2007/09/22/washington/22emergency.html?th&emc=th