Thousands legally in state lost care, but a surplus could provide relief

Md. health cuts exact toll on immigrant kids


The medical forms completed on behalf of Brayan Herrera said this: Without continued treatment for a rare blood disease, the 8-year-old Maryland boy could die.

His treatment ended anyway.

Brayan is a member of a relatively new class of Maryland residents: legal, newly arrived immigrant children stripped of state-assisted health care.

Last year, Gov. Robert L. Ehrlich Jr., pointing to budget difficulties, cut the $5.5 million set aside for legal immigrant children who have been in the country less than five years and whose families have income below certain limits. He also cut a $1.5 million program to provide recently arrived pregnant immigrants with prenatal care. His office declined last week to comment on the cuts.

This year, with a state surplus hovering around $1 billion, neither the governor nor the legislature has restored the Medical Assistance program funds that care for the immigrant children or pregnant women.

The result: Brayan and about 3,000 other Maryland children, some healthy and others ill, lost their medical coverage along with about 800 women in need of prenatal care. The state Senate is scheduled to hold a hearing today on legislation to add funds for immigrant health care but without restoring the insurance program.

"From a public health perspective, providing primary care reduces illness, disability and death, and there is a mountain of evidence to support that," said Dr. Joshua Sharfstein, Baltimore's health commissioner. "If you're relying on a system that will treat only complications, you're ensuring kids will get sick."

The $7 million is a small fraction - 0.175 percent - of the $4 billion the state will spend on Medicaid-related coverage for residents.

The Maryland Hospital Association, through a spokeswoman, said last week that the cut is adding to an already daunting problem: Unpaid medical care in Maryland increased $143 million, from about $546 million in fiscal 2004 to $689 million over the past fiscal year.

Although the program was directed toward indigent immigrants, many of the families it had benefited have jobs, but they are often low-wage jobs that carry no health insurance.

The Institute of Medicine, part of the National Academy of Sciences, has repeatedly found in studies that the type of primary care eliminated by the state promotes healthier children and can save lives.

"We've worked very hard," said Brayan Herrera's mother, Martha Herrera, 46. She has cleaned houses while her husband, Marcial, 56, has worked construction since emigrating from Mexico in 2003. "How can they do this to my child?"

The governor's budget does add $3 million for a one-year "immigrant health initiative," to be divided among a few county health departments to improve care.

That does not restore insurance, though, for the legal immigrant children or pregnant women who have been cut from the Medical Assistance program. Last month the House passed a bill directing the governor to continue his new initiative into 2008; that is the subject of the Senate's hearing today.

The state's Department of Health and Mental Hygiene, pointing to a lawsuit filed by the Legal Aid Bureau aimed at reversing the cuts, declined to provide information on whether the $7 million cut saves money, given corresponding increases in emergency care.

State Health Secretary S. Anthony McCann said last summer that the cuts were consistent with federal law and that legal immigrants could be helped with health care costs by the people who vouched for their entry into the country.

"The fact is, they have sponsors," McCann told a legislative panel at that time. "They have alternatives."

Attorneys for the Legal Aid Bureau argue that because a single class of Maryland resident has been singled out for cuts, the governor's budget violates equal protections guaranteed by the state's constitution.

After Legal Aid filed suit - and nine months after the budget cut ended Brayan's coverage - the state enrolled Brayan in an alternative program that partially restores treatment for his blood disease, histiocytosis. His lawyers contend that the state is placing a small number of children like him into alternative programs in response to the lawsuit but that the vast majority of children who lost insurance are still not covered.

"People have been polarized over the whole issue of immigration, but treating sick kids isn't something we should be disagreeing about and certainly not something that should polarize the state," said Del. Victor R. Ramirez, a Prince George's County Democrat. "If you can help a sick kid, you do it - period."

Evolving history

Maryland's Medical Assistance program was established in 1945, promising medical care to all indigent residents, regardless of whether they were citizens. In 1967, Maryland joined the federal Medicaid program, which provided federal matching funds for medical treatment provided to legal immigrants, including pregnant women and children.

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