The ACLU of Rhode Island has called on local hospitals to reject anticipated earmarked federal funding for immigrant health care that could have a serious and negative health impact on undocumented immigrants in the state.

A federal law enacted last year, and nearing implementation, makes $250 million per year in federal funds available for four years to compensate health care providers for the cost of caring for undocumented immigrants. But because compensation depends on a patient’s undocumented status, providers wishing to obtain a share of this funding may be forced to perform invasive questioning to make a “citizenship determination” for each uninsured patient.

In a two-page letter sent to local hospital administrators, RI ACLU executive director Steven Brown argued that “the inquiry will likely place both providers and patients in deleterious positions.” Under draft guidelines prepared by the federal agency administering the program, providers would be charged with obtaining “acceptable evidence” of a patient’s illegal status. “The pointed questions and demand for invalid documents,” says the ACLU letter, “will doubtless raise fears of legal consequences. The unfamiliar hospital environment, language barrier, and possible physical discomfort can only increase anxiety. Some immigrants should be expected to postpone or forgo medical care because of such fears, harming both themselves and general public health.” In addition, the proposed guidelines contain no confidentiality protections for the information provided.

The ACLU’s letter noted that alternative approaches to providing information – using statistical models, for example – have been suggested by concerned commentators as a way of fulfilling the law’s goal without invading the privacy of – and possible scaring away – patients in need of hospital care. However, it is quite uncertain whether this approach will be adopted.

In anticipation of adoption of the federal agency’s guidelines, the ACLU letter urges hospital administrators in Rhode Island to forego acceptance of the federal funding if immigrant status determination is a condition of receipt of those funds. The ACLU has not yet received any responses to the letter, which was sent out last week. Such diverse groups as the National Immigration Law Center and the American Hospital Association have also objected to the proposal, which is expected to be finalized in the next few weeks.