Immigration debate hits home for liver transplant patients
The state funded the procedures for two young illegal migrants. But when they hit 21, coverage passed to L.A. County, which doesn't have the resources to implant the new organs they both needed again.
By Anna Gorman, Los Angeles Times Staff Writer
April 13, 2008
Ana Puente was an infant with a liver disorder when her aunt brought her illegally to the U.S. to seek medical care. She underwent two liver transplants at UCLA Medical Center as a child in 1989 and a third in 1998, each paid for by the state.
But when Puente turned 21 last June, she aged out of her state-funded health insurance and was unable to continue treatment at UCLA.
This year, her liver began failing again and she was hospitalized at County-USC Medical Center. In her Medi-Cal application, a USC doctor wrote, "Her current clinical course is irreversible, progressive and will lead to death without another liver transplant." The application was denied.
The county gave her medication but does not have the resources to perform transplants.
Late last month Puente learned of another, little-known option for patients with certain healthcare needs. If she notified U.S. Citizenship and Immigration Services that she was in the country illegally, state health officials might grant her full Medi-Cal coverage. Puente did so, her benefits were restored and she is now awaiting a fourth transplant at UCLA.
Puente's case highlights two controversial issues: Should illegal immigrants receive liver transplants in the U.S. and should taxpayers pick up the cost?
The average cost of a liver transplant and first-year follow-up is nearly $490,000, and anti-rejection medications can run more than $30,000 annually, according to the United Network for Organ Sharing, which oversees transplantation nationwide.
Illegal immigrant children with certain severe, chronic illnesses are eligible for funding under a state program called California Children's Services. But the coverage ends when they turn 21. After that, they can receive free or low-cost treatment through county services for the medically indigent and, in some cases, emergency Medi-Cal. But in Los Angeles County, doctors said neither program covers liver transplants.
State health officials said California law is designed so there is no gap in coverage, so children move seamlessly from state-funded treatment to county care. But that doesn't always happen. When they become adults, patients like Puente often have to switch doctors and hospitals and may lose access to necessary care.
If illegal immigrants inform the state in writing that U.S. immigration services "is aware of their presence and does not plan to deport them," they could be eligible for full-scope Medi-Cal, said Norman Williams, spokesman for the state health department. Medical condition is one factor that would make immigrants eligible for coverage.
The immigrants send a form to Citizenship and Immigration Services, but the agency said it does not respond to patients or make any promises about their immigration status.
Immigration debate hits home for liver transplant patients - Los Angeles Times