N.C. Supreme Court: Illegal immigrant not entitled to Medicaid

The Associated Press
RALEIGH, N.C.

An illegal immigrant did not have an emergency medical condition when he received chemotherapy and Medicaid should not have been covered his treatment, the state Supreme Court ruled Friday in reversing a lower court decision.

Medicaid only allows states to be reimbursed for Medicaid costs of illegal immigrants when medical treatment is deemed an emergency, according to court records.

The N.C. Supreme Court noted a doctor who testified that without treatment Guatemala native Hector Diaz's condition eventually would have been an emergency. But his condition didn't meet that threshold during chemotherapy, the doctor said.

Diaz's condition during chemotherapy "was stable and, therefore, he was no longer entitled to Medicaid coverage," the court said.

Court documents say that in October 2000, Diaz came down with a sore throat, nausea, vomiting, and other ailments that were later diagnosed as symptoms of leukemia.

He was treated at Moses Cone Memorial Hospital in Greensboro beginning that month, including intermittent chemotherapy treatments through July 2002.

Diaz authorized the medical provider to seek Medicaid coverage but the state Division of Medical Assistance approved coverage for only a portion of his medical care that didn't include chemotherapy. The chief hearing officer of the North Carolina Department of Health and Human Services approved the decision.

Diaz appealed to the Guilford County Superior Court, which reversed the state agency's decision.

"Payment by Medicaid is not limited to emergency services; rather, Medicaid shall pay for all care and services as are medically necessary for the treatment of an emergency medical condition," the Superior Court ruled.

The state appealed to the N.C. Court of Appeals, which unanimously upheld the trial court ruling in favor of Diaz.

The state's highest court reviewed the decision and on Friday ruled in favor of the state, sending the case back to the Court of Appeals.

Tom Cone, an attorney whose office in Greensboro represented Diaz, said he didn't believe the Supreme Court accurately interpreted the Medicaid statute.

"We think that the statute says once a medical emergency is established then it should be treated and Medicaid ought to cover that treatment, not just for a set period of time," he said.

Cone declined to comment on the status of Diaz and didn't know yet what would be the next step in the case.

William Gheen, president of the Raleigh-based group Americans for Legal Immigration Political Action Committee, said covering chemotherapy was "a pretty close call because you may die without the chemotherapy."

"The biggest question mark behind this court case is the negative impact on our entire hospital system caused by illegal immigration," he said.

Copyright 2006 The Fayetteville (NC) Observer

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