Copyright 2000 Star Tribune
Star Tribune
(Minneapolis, MN)
February 19, 2000, Saturday, Metro Edition
SECTION: NEWS; Pg. 1A
LENGTH: 1106 words
HEADLINE:
HIV-positive refugees prompt questions about medical costs
BYLINE: Mark Brunswick; Mary Lynn Smith; Staff Writer
BODY:
As many as 20 HIV-positive refugees may
arrive in Hennepin County within the next several weeks as part of a federal
program waiving restrictions on their immigration.
The arrangement has county officials
concerned about long-term health and social costs and state authorities worried
about adequate planning.
Minneapolis is
one of six cities selected by the nonprofit organizations overseeing the
resettlement to receive the refugees, in part because of its "excellent" network
of social and financial services for AIDS and HIV patients, said Dr. Alan Lifson
of the Minnesota Department of Health. Another reason is to reunite the refugees
with relatives already in the area.
But
Hennepin County Board Chairman Randy Johnson described the arrangement as
"ill-timed" and has raised concerns to U.S. Sen. Rod Grams and others about the
potential financial impact to county taxpayers.
Last month Lifson wrote a letter to
federal authorities expressing "serious concerns about rushing this process
without adequate time for planning," saying issues such as housing, possible
citizen unease and proper medical care had yet to be addressed. Since then, a
coalition of agencies has been convened to try to work out the concerns.
County officials say that an eight-month
federal transition fund for the refugees, as well as Medicaid payments and other
federal funding for medical care, probably won't cover the costs of an
HIV-positive client.
Johnson, while
supportive of lessening restrictions on immigration, said the HIV-positive
refugees will arrive with significant needs.
"Inevitably, they are going to have much
higher health-care needs than people who are not HIV-positive," he said. "We
already have an acute shortage of housing in Minneapolis and Hennepin County
now. Our hospital is in great stress, in large part because of funding changes
by the federal government. Will they supply adequate funding for this? I don't
believe that for a minute."
Ramsey County
isn't slated to receive any of the current wave of refugees, but county
officials there agree that the federal government will pony up some money. "It's
a federal decision and the dollars should follow them," said Dr. Neal Holtan,
the county's medical director.
.
Questions remain
Local resettlement will be handled through
a federal contract with Lutheran Social Services. Given the "crisis" nature of
resettlement, Betty Hayes, director of Refugee Services and Employment Programs,
said it is not clear how many HIV-positive refugees will come to the metro area
or how long the process will take. HIV-positive refugees have settled here in
the past, but in smaller numbers than those anticipated now.
Local and state health officials have been
told that about 20 HIV-positive refugees, most of them Somali, can be expected
within several weeks. An estimated 80 others are expected to be sent to Boston,
New York City, Chicago, San Diego and San Francisco.
The United States refuses entry to people
with HIV, the virus that causes AIDS. Those with refugee status _ meaning their
lives could be endangered if they stayed in their country _ can be exempt from
that law, but typically, only a handful of waivers have been granted a year.
The major roadblock for those seeking
waivers was a requirement that any health costs associated with the resettlement
be approved before arrival. Many refugees were unable to obtain those kind of
assurances, either from an insurance carrier or from local or state health
departments.
But U.S. Immigration and
Naturalization Service policies were loosened last year, under the belief that
federal programs meet the funding requirements. As a consequence, several
hundred HIV-positive refugees are expected to arrive in the country over the
next couple of years, according to a U.S. State Department official working with
the resettlement programs.
Given the wide
spectrum of the seriousness of the illness and differences in treatments, AIDS
experts say it is difficult to determine the average cost of caring for an
HIV-positive person.
Federal funding can
come from Medicaid and the Refugee Medical Assistance program, and from a
program that provides home care, transportation, counseling, and hospice care
for people with AIDS or HIV: the Ryan White CARE Act, named for
an 18-year-old from Kokomo, Ind., who died of AIDS complications in 1990.
In addition, many people who are
HIV-positive in Minnesota receive medical care through a high-risk insurance
pool, with the state paying premiums for low-income recipients, said Julia
Ashley, a program manager for the Minnesota Department of Health.
Nevertheless, Johnson met last week with
representatives for Grams to express concerns about the potential local costs.
Grams has not taken a position, but his office is looking into the financial
implications and possible citizen concerns about the overall number of refugees
resettling in the metro area, said Steve Behm, a spokesman for the senator.
"We are clearly willing to do our share.
We have," Johnson said. "But policing the borders and immigration policies must
be a national, federal decision. It must be funded nationally by the federal
government. I'd feel better about this if the federal government delivered a
blank check to me and said, 'Deal with this.' But it isn't going to happen."
.
Contributors to society
The United States will resettle about
90,000 refugees from all over the world this year. Except for the right to vote,
they are afforded all the rights of citizens, including access to health care
assistance.
Hayes said it isn't clear how
sick the HIV-positive refugees might be; many may be employed for long periods.
"These are people paying taxes and making
a positive contribution, with their energy, their culture and their language,"
she said.
Said Holtan: "If they're
infected but not ill, there will be few social costs. . . . I think we can
afford it. The impact won't be a huge burden."
Officials in Ramsey County said the county
eventually may feel the effects if some refugees move or another wave arrives
later.
"It's something that we may need to
be concerned about," said Rob Fulton, director of the St. Paul-Ramsey County
Department of Public Health. Costs to the public could include housing, hospice
care, assisted living and employment services, he said. But Holtan said he
hasn't heard any protests to the proposal. "This is a humanitarian program.
These people won't survive if they're left there."
LOAD-DATE: February 21, 2000
