Cost of Illegal Immigrants Threatens to Bust County Health Care Budget

A conflict between state and federal law in defining the term “residency” has the county’s indigent health care office scratching their heads.

While federal statutes define a resident as a citizen or qualified alien, state law extends residency to anyone with a Texas address. By definition, the latter has put the office in a sort of conundrum when handling health care applications from otherwise eligible illegal immigrants who, per the state’s “residency” requirements, have been able to sap the county for up to $30,000 per person in annual medical expenses.

In an effort to clarify and define Tom Green County’s role as an indigent healthcare provider, County Treasurer and Indigent Health Care Director Dianna Spieker is seeking an opinion from the Texas Attorney General.

“There is an existing gray area of law that you have to be a resident of the county in which you are applying for indigent health care,” Spieker said. “Because it says resident, that opens the door for illegals applying for health insurance no matter what country they come from. What I’m asking the Texas Attorney General is which law trumps: state or federal.”

Tom Green County is required by state law to spend up to 8 percent of its annual revenue on indigent health care, which equates to roughly $2.8 million, Spieker said. After meeting that 8 percent threshold, the county is eligible for state assistance, doled out on an if-we-have-it basis and in a sum that Spieker described as “minimal”.

At the present, Tom Green County spends an average of $2 million annually on indigent health care; currently, there are approximately 650 active clients. The number of clients represents roughly a quarter of those who actually apply, Spieker said, and “probably 25 percent of the people who come in to complete an application are here illegally”.

Spieker took over the role of director for the local indigent health care office in 2009. At that time, there were several individuals pulling monies from the county who could supply no proof of citizenship or qualified alien status, she said.

In order to satisfactorily prove residency, a person need only submit documentation placing that person at Tom Green County address, and could include a utility bill, a driver’s license or ID card, or a letter of support written by another individual who knows the applicant to be a resident of the county, Spieker explained.  The TGC commissioners’ court in 2013 added a stipulation that applicants present a Texas driver’s license or ID card with a local address as evidence.

“The issue is that the county is the payer of last resort,” Spieker said. “The people that we help are the people that fall through the cracks. Our first job is to find out if they qualify for other state and federal assistance. If it is determined during the application process that you are an illegal immigrant but you meet all other eligibility requirements, we are bound by [state] law to provide coverage.”

Successful applicants for indigent health care are awarded an insurance-type card that allots them $30,000 for medical coverage per year. Also included is full payment of up to three prescriptions per month. Services are provided to indigent health care cardholders at participating local hospitals and, once the $30,000 max has been met, a client must wait until a year from the initial issue date to reapply.

As a state-mandated service, Tom Green County is required to give up to the aforementioned 8 percent in health care assistance; however, once that requirement is met, the county’s responsibility ends at the bottom of the coin purse, replenished again in the following budget cycle.

“In past years—15-20 years ago—the county actually stopped the program,” Spieker said. “We met what the state required us to do, and we had no additional funds.”

In accepting applications from illegal immigrants, she warned, the county’s indigent health care office could face another shutdown like the one back in the ‘90s, stopping all funds to even legal residents who are eligible for services. The last time it happened, Spieker said, TGC could not pay for any indigent medical services for roughly two and a half months.

“If I’m a good steward of my county’s—our constituents’—tax dollars, I don’t think our dollars should be spent on somebody that is an undocumented or illegal immigrant,” she said. “I can empathize with them and realize that they need help too, but I just don’t think county government should be the responsible party.”

Noting the complexity at the heart of the issue, Spieker said had the county’s legal department draft a request for an attorney general opinion seeking clarification and definition on how her office is to proceed. That request was dated July 27, and as of yet, no response has been given.  

“It’s hard when you take your oath of office to uphold the laws and you have conflicting and gray area law,” she said. “In reaction to the influx of immigrants, I felt like we needed to know what our role was and have that clear and defined.”