BRIAN BYRNE, Times staff writer
St. Vincent Frankfort Hospital Administrator Tom Crawford is unyielding in his hospital's approach to patient care: It turns away no one.
Yet Crawford, as other healthcare and welfare officials attest, the system is in place to serve the needy, and no one segment of the population is draining it.
"We're committed to serving all persons with special attention to those that are poor and vulnerable," Crawford says. "We're trying to be very vocal in the message that they are safe seeking healthcare here, and I believe we have been effective in that."
Not only does the hospital not discriminate, he said, it encourages all residents - including undocumented immigrants - to look to St. Vincent for their medical needs.
"Is there utilization of the health care system by people who are undocumented residents? I'm sure that there is," he said. "Is it creating an unbearable financial strain? No."
Crawford said some people may interpret his denial of a negative impact by illegal immigrants as an attempt to avoid community backlash. Still, he maintains St. Vincent's pledge to serve all has not been hindered.
"If anyone wants to make controversy of that, I'm willing to have controversy," he said. "But that's the way it's going to happen in our little corner of the world."
Because the hospital is covered under the Emergency Medical Treatment and Active Labor Act, it turns no one away, regardless of patients' ability to pay, he said. Neither is anyone denied service based on immigration status because when patients check in, they are not asked for Social Security numbers or immigration status, he said.
Crawford asserts that because undocumented residents lack a clear understanding of the healthcare system, they often are reluctant to pursue medical treatment.
"I think that in any instance when you go into the healthcare system there's a certain amount of fear and trepidation," he said. "So I can only imagine if you're in a strange environment and you're not feeling well, you might be hesitant to seek services."
Medicaid costs skyrocket
Crawford estimated that each year at St. Vincent, 250 mothers receive emergency Medicaid for birthing expenses, with each ranging $1,500-$2,000. There is no dominant demographic among these cases, he said, thus he was unable to determine how many of the mothers are illegal immigrants.
Despite Crawford's view that illegal immigrants do not burden healthcare costs, based on his estimate, the cost for childbirth in Clinton County ranges $375,000 to $500,000 annually. In response, Crawford noted that without Medicaid reimbursement to hospitals, costs overall would rise for all patients and charity cases, in turn, would increase.
According to St. Vincent Health Access Coordinator Marcy Fonfrias, undocumented immigrants who meet state financial guidelines are eligible for emergency Medicaid under four circumstances: the elderly, the disabled, low-income families, and delivery of a child.
The illegal immigrants are aware of the availability of emergency Medicaid, Fonfrias said. However, she added, they do not constitute a disproportionate number of the local hospital's Medicaid patients.
"They should be grateful for what they're getting," she said. "And they are, believe me."
Born in Puerto Rico, Fonfrias has lived in Clinton County for 11 years and has worked at St. Vincent for three. Her job includes helping patients locate doctors, facilitating Medicaid applications and coordinating interpreters, which the hospital is required by law to provide and pay.
No one ethnic group dominates the approximately 50 patients Fonfrias sees per month, she said, although, most are low income.
Fonfrias said the majority of undocumented residents do not seek preventative and follow-up care, as the Medicaid they are eligible for does not cover these expenses.
"In general, the big majority (of undocumented residents) don't come," she said. "Usually they don't seek medical assistance."
Diabetes and on-the-job injuries are common in the Hispanic community, she said, noting that she often tells patients about alternative healthcare resources, including the Open Door Clinic.
Clinic's door always open
"We don't see anything beyond the person," the clinic's executive director, Nora Tribble, said. "You can't choose the poor."
To receive services at the faith-based clinic, a patient must meet poverty-level income guidelines, be uninsured and reside in Clinton County. While identification is requested, the clinic does not consider residential status, she said, noting that 97 percent of patients are the working poor.
While undocumented immigrants continue to be the source of heated debate locally, many of these individuals have become hesitant to make themselves visible in the community, Tribble said. Until a year ago, roughly 48 percent of the clinic's patients were Hispanic, she said. Now that number is down to roughly 27 percent.
"Many people distrust," she said. "They don't know who to trust anymore. I just wish we could get the message out that we're a safe place to come."
The clinic opened in 1990. It receives no federal funding, just $20,000 from the state. The majority of funds comes from area churches, individuals and local grants, Tribble said.
"We do what we're able to do with what we have," she said.
Patients are asked for a small donation for the services they receive, and Tribble has found Hispanic patients eager to pitch in.
"The Hispanics are the ones that don't walk past the donation can," she said. "They always give. I wish everyone could see the people that we see because these are good people."
Social services
In Clinton County, and the state as a whole, undocumented immigrants' access to social services is limited, according to information supplied by the Indiana Department of Family and Children Services.
Its data shows that in December 2006, $287,000-worth of food stamps were issued to Clinton County residents. That amount jumped in December 2007 to $332,000. Additionally that month, $3,334 in Temporary Assistance for Needy Families went to 66 Clinton Countians.
How this translates to illegal immigrants is answered by Lauren Auld, director of media relations for the Indiana Family and Social Services Administration.
"Illegal aliens, or undocumented aliens, are not eligible for TANF or food stamps, period," Auld wrote in a Feb. 1 e-mail to The Times. "If a household contains a combination of (undocumented residents) and U.S. citizens, we'd have a household where some are not eligible, others eligible."
Aside from Medicaid, undocumented residents are ineligible to receive any social service benefits from the FSSA, that administration's secretary, Mitch Roob, told The Times in a phone interview Feb. 27. However, he noted, the U.S. citizen children of these undocumented residents are.
That designation can contribute to confusion regarding undocumented residents' effect on Indiana's social services, Roob said.
"Undocumented aliens do not (have a draining effect)," he said. "The children of undocumented aliens may, but (only if) they are American citizens."
According to the Social Security Administration, undocumented residents are ineligible for Social Security or Supplemental Security Income.
However, Roob acknowledged that some individuals do manipulate the system.
"To believe that no fraud is going on is the height of naiveté," he said.
County agencies are generally charged with verifying applicants' identification, Roob said, noting that falsification of official IDs is a felony that could lead to deportation.
Although, as Roob pointed out, "An undocumented alien risks deportation by their very presence here in America."
Representatives from the Clinton County Department of Family and Children Services declined to participate in this story because, they said, all inquiries must be answered at the state level.
Other resources
In Clinton County, undocumented immigrants can receive support from The Salvation Army once a month. To be eligible for that organization's food pantry, an application and income verification are required along with identification in the form of a utility bill or school ID. Additionally, applicants must be 18 years or older or legally emancipated, and every member of the household must provide identification.
"I don't care who the child is," Director Linda Tegarden said. "We're here for the families."
Tegarden said about 225 families accept help from the food pantry each month. She estimated that 2 percent of them are Hispanic.
"We're surprised if we see two families a month," she said, adding that because the organization does not require proof of citizenship, it is impossible to determine how many of these are undocumented.
Tegarden attributes the low number to her belief that the Hispanic community tends to depend on family and friends for assistance.
Conclusion
Local healthcare officials, two state FSSA spokespeople and the local Salvation Army Service Center director all contend that the impact of illegal immigrants on the county's healthcare and welfare system could be a criticism that has been greatly exaggerated.
While St. Vincent Frankfort Hospital maintains a policy of healthcare for everyone without regard to immigration status, according to Crawford there is no way to determine how much a specific demographic costs the local hospital.
The system is in place to serve the needy, and no one segment of the population is draining it, he said.
The amount of dollars spent by the hospital for charity care has increased over the past few years, Crawford said. Yet he attributes that to a declining economy in Clinton County and not to a stronger presence of undocumented immigrants.
"I cannot lay that at the feet of the Hispanic community," he said. "We have a significant increase in charity care that applies to people that were born and raised in the United States."