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Who Pays for Uncompensated Kidney Care in the U.S.?


An estimated 6,500 undocumented immigrants in the U.S. are living with end-stage renal disease (ESRD), according to a study published in the American Journal of Kidney Diseases. The availability of standard hemodialysis for these immigrants varies from state to state. Many states offer emergency-only hemodialysis, while others offer standard hemodialysis.

States like California, New York and Washington, offer standard hemodialysis using non-federal funds.

So, who should be responsible for the care of undocumented immigrants?

A discussion on RPA Connect, hosted by the Renal Physician Association, aims to provide some answers.

Undocumented immigrants with ESRD are not eligible for the 1972 Medicare ESRD entitlement program or full-scope Medicaid coverage and are specifically excluded from provisions of the Affordable Care Act.

“The current reimbursement system for the care of undocumented persons with end-stage kidney disease is inadequate to provide the standard of medical care in most states,” Brendan Bowman, M.D., chair of RPA’s government affairs committee and a nephrologist with the University of Virginia Health System, said in a statement to MedTech Boston.

In the ongoing online discussion, members have presented individuals with questions to unearth the changes that can be made at different levels to improve access to chronic kidney dialysis.

Many experts believe expansion of Medicaid is an important step.

“For undocumented immigrants, enhancement of state-level Medicaid coverage to include advanced chronic kidney dialysis, dialysis and transplant would improve access and quality of care to these underserved groups,” wrote Yoshio Hall, M.D., associate professor in the nephrology division at the University of Washington.

Nephrologists are also discussing obstacles they encounter in delivering dialysis to uninsured or undocumented patients.

Depending on your state or venue, kidney care could present challenges for the provider.

Providers could be limited to providing “emergency only” dialysis in the emergency department or might be practicing in a state that provides dialysis reimbursement, but no provider reimbursement, Bowman wrote in the discussion.

New York provides Medicaid to cover dialysis, so patients can receive hemodialysis or peritoneal dialysis, wrote George Coritsidis, M.D., a nephrologist and professor at Mount Sinai Health System.

Coritsidis added that many patients work and need early or late shifts and that there are compliance issues to time on hemodialysis.

Other talking points in the discussion include how soon patients can be eligible to receive outpatient services after the initial application to Medicaid.

“As health systems and local and state governments wake up to the costs and consequences of a lack of ESKD coverage for patients within their borders, states with common sense Medicaid solutions can provide a model that saves the lives of our patients and benefits the taxpayer,” Bowman said. “That is something we can all get behind.”

Join RPA Connect’s conversation on who should pay for uncompensated kidney care in the U.S. today.


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