The federal Centers for Medicare and Medicaid Services issued guidelines this week for states to seek reimbursement for health services provided to immigrants.  This could provide relief to local communities where immigrant populations have grown dramatically in recent years, but the federal funds will solve only part of the problem.

Under the federal guidelines, states and local communities that have had to spend hundreds of millions of dollars providing health care to immigrants can now seek at least partial compensation. California, for example, could receive more than $70 million a year and Texas would get close to $46 million.

The payments are far short of what many local hospitals say they are spending on charitable care for immigrants.

Margaret Althoff-Olivas, spokesperson for Thomason Hospital in El Paso, Texas, says the estimated $2 million her institution could claim falls far short of the more than $150 million spent each year on all emergency care, but it is still welcome.

"Well, $2 million is a lot better than zero," she said.

She says there is no way of knowing how many of the people seeking emergency care at the hospital are illegal aliens, since staff are not permitted to ask, but in border cities like El Paso, the percentage is believed to be quite high.

What is important, according to Ms. Althoff-Olivas, is that this mechanism to pay hospitals represents an important step by the federal government towards addressing the burden of illegal immigration on local governments and public hospitals.

"This is really the first time that the federal government has acknowledged that the immigration issue is a federal issue and not an issue that should be pushed down to the local communities to pay for," she noted.

But Cecilia Munoz, vice president for policy at the National Council of La Raza, a Latino-rights organization, says the new measures could do more harm than good.

"Our biggest fear is that it will deter some people from seeking emergency care because they are worried about what happens when their documents get checked and any time you discourage people from seeking emergency care, you are endangering the public health," she explained.

Thomason Hospital's Margaret Althoff-Olivas, however, says the federal guidelines do not require care providers to conduct document checks.

"What hospitals and doctors and ambulance services must do is bill the government on a case-by-case basis, a patient-by-patient basis, in other words.  To determine if a patient is eligible, the government has given us certain 'indirect questions to ask,'" she said.

But Ms. Munoz says such guidelines will be difficult to follow without entering into the complicated web of legal rules governing immigration status.

"In general, it is probably a good thing for the federal government, which has authority over immigration policy, to compensate the states for the costs of providing emergency care," she added.  "What's difficult here is the mechanism for doing it.  What the federal government is asking hospitals to do is ask people for any one of a long list of documents to demonstrate whether a person is here legally or not and that is a pretty serious administrative burden on hospital personnel."

Those who favor more restrictive immigration policies argue that the costs of health and social services that are borne by state and local governments amount to a subsidy for certain industries that benefit from cheap immigrant labor.  In most cases, the companies hiring illegal immigrants do not pay for health care, even in cases where a worker is injured on the job.

Cecilia Munoz says Latino groups want to address these problems with comprehensive immigration reform.

"If there is a consensus on anything on this issue it is that our system is out of control and needs to be fixed," she noted.  "There is no community more aware of that than the Latino community in the United States.  This country can and should know who is here and know who is coming.  We need reforms that recognize that we depend on the hard work that immigrants do and give them the ability to get on a path to citizenship and create a way to regulate the immigration stream that is going to come in the future."

President Bush has proposed a guest-worker program to address the problem, and bills introduced in Congress this week aim towards a general reform of the system.  But as contentious as this issue is, there is likely to be a long, hard debate before any proposal is approved.