The state’s health care program for indigents might have to pay for more care for illegal immigrants, under a ruling of the Arizona Supreme Court.

In a 4-0 opinion released Aug. 21, the state Supreme Court ruled that the Arizona Health Care Cost Containment System cannot stop paying hospitals for the care of indigent illegal immigrants just because the conditions of the patients have improved to the point that they can be moved out of acute care into another ward.

“The realities of medical treatment and patents’ responses to treatment do not lend themselves to such bright line distinctions,” Justice Michael D. Ryan wrote for the court. “Instead we conclude that even though an initial injury may be stabilized, that does not necessarily mean the emergency has ended.” Concurring were Chief Justice Charles E. Jones, Vice Chief Justice Ruth V. McGregor and Justice Rebecca White Berch. Although Justice Stanley Feldman heard arguments in the case, he retired from the court before the opinion was filed.

The ruling arose out of two separate lawsuits that were consolidated to settle the issue of when and how AHCCCS can stop paying for the care of needy illegal immigrants beyond the immediate care needed to treat them in an emergency room. The ruling sends the two cases back to Superior Court using the opinion for guidance.

In determining whether AHCCCS must continue to pay for the care of needy illegal immigrants beyond emergency-room care, the opinion states: “The focus must be on whether the patient’s current medical condition — whether it is the initial injury that led to admission, a condition directly resulting from that injury, or a wholly separate condition — is a non-chronic condition presently manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical treatment could result in one of the three adverse consequences listed in [Section 1903 of the U.S. Social Security Act].” The Social Security Act includes provisions for Medicaid, the federal health care program under which the AHCCCS program operates. The three “adverse consequences are “placing the patient’s health in serious jeopardy,” “serious impairment to bodily functions,” and “serious dysfunction of any bodily organ or part.”

“…It is neither practical nor possible to define with more precision when an emergency medical condition has ended,” Justice Ryan wrote. “Rather, such determinations should largely be informed by the expertise of health care providers.”

AHCCCS Examines The Ruling

Frank Lopez, a spokesman for AHCCCS, said the agency is still assessing the implications of the ruling.

AHCCCS now spends upwards of $80 million a year to treat about 3,000 illegal immigrants a year, Mr. Lopez said. The federal government pays about two-thirds of that cost while the state picks up the rest.

Among the plaintiffs in the original lawsuits that led to the Supreme Court ruling are Scottsdale Health Care and Banner Health System, the latter of which operates Good Samaritan Regional Medical Center in Phoenix.

The case number is CV-02-0190-PR. —