In January, the state’s flagship safety net hospital, Denver Health, distributed a one-page notice about patient privacy that carried ground-shaking implications, especially for Colorado’s immigrant population.
The notice stated that due to federal changes within Medicaid, the federal-state program for millions of low-income and disabled Americans, “limited” personal information could be shared with U.S. Immigration and Customs Enforcement.
This story was produced as part of the Colorado Capitol News Alliance. It first appeared at cpr.org.
Denver Health said the information applied only to people who are not lawfully residing in the U.S and are enrolled in a program called Emergency Medicaid or are pregnant and enrolled in Medicaid through Cover All Coloradans.
But if a person is in one of those groups, the Centers for Medicare and Medicaid Services “may share limited information with ICE, including your: citizenship and immigration status, address, phone number, date of birth and Medicaid ID.”
CPR obtained a copy of the notice, which had been circulating publicly. Denver Health said the hospital aimed to alert staff to the policy.
Denver Health declined an interview request. But in an emailed statement, the hospital restated its commitment to patients. “Denver Health remains a place that is safe for patients to continue receiving care,” the statement said.
Last summer, Colorado and nearly two dozen states sued to challenge the disclosure of Medicaid data with immigration authorities. A federal court denied that motion at the end of last year and is allowing data sharing in limited circumstances, as the case continues through the courts.
Providers and advocates expressed deep concern about both the initial court ruling, as well as the notice. They worry it will scare both undocumented immigrants and others who aren’t citizens to skip health care altogether. That includes care states have informed people they’re eligible for.
“It’s devastating to think that people need to choose between their health and their safety, right? And keeping their families together,” said Gladis Ibarra, co-executive director of the Colorado Immigrant Rights Coalition/CIRC Action Fund.
Ibarra described health care as a basic human need along with housing and food.
CPR reached out to the U.S. Department of Health and Human Services and the Department of Homeland Security. A spokesperson said HHS does not comment on ongoing litigation.
DHS defended the data sharing and said it was necessary because of the failed immigration policies of the prior administration.
“President Trump consistently promised to protect Medicaid for eligible beneficiaries,” said Assistant Secretary Tricia McLaughlin. “To keep that promise after Joe Biden flooded our country with tens of millions of illegal aliens, CMS and DHS are exploring an initiative to ensure that illegal aliens are not receiving Medicaid benefits that are meant for law-abiding Americans.”
Some Democratic state lawmakers called the situation incredibly frustrating.
“This is medical care, we want people to be able to access services when they need them,” said state Rep. Elizabeth Velasco of Glenwood Springs.
Velsaco sponsored a bill last legislative session to prohibit the state and public entities from sharing personal information with ICE unless there is a criminal investigation. Denver Health told CPR News that the hospital has robust policies that limit the sharing of information with law enforcement and will continue vigorous efforts to “protect all patient information.”
But that doesn’t mean some patient information won’t potentially reach immigration authorities even if Denver Health and other Colorado hospitals aren’t actively sharing it.
“I believe this is eroding trust in government and it’s attacking our communities,” said Velasco “We’re trying to work around the federal government and we believe it is our duty to serve everyone but there are some pieces we are not able to address, those are at the federal level.”
“We cannot directly control what CMS shares,” state says
A spokesman for the Colorado Department of Health Care Policy and Financing said federal law requires the department to share certain basic information with Centers for Medicare and Medicaid Services — the federal agency that runs Medicaid — because Medicaid is jointly financed and administered by the state and federal government.
These monthly reports include demographic and eligibility information, such as name, address, date of birth, Social Security Number (if provided) or Medicaid ID, and immigration status for each Medicaid member who receives services.
The department only shares Medicaid information with Centers for Medicare and Medicaid Services, he said. It does not share information with federal immigration officials, although as this communication outlines, “we cannot directly control what CMS shares.”
The federal judge in the multistate lawsuit seeking to prevent Centers for Medicare and Medicaid Services from sharing data with immigration authorities said the CMS may share certain data with the Department of Homeland Security “about individuals who are not lawfully residing in the U.S.” said HCPF spokesperson Marc Williams.
“To date, CMS has not provided Colorado guidance on whether or how this specific information might be shared,” he said in an emailed statement, noting the agency understands people are concerned about whether Medicaid information could be used for federal immigration enforcement.
The Colorado Attorney General’s Office reads the judge’s decision as a narrow exception that allows CMS to share limited information described as basic identifying data (name, address, phone, citizenship data, birthdate, Medicaid ID), but not medical details or broader personal information.
Attorney General Phil Weiser, a Democrat who is running for governor, criticized the federal government’s data collection and sharing push when the state, along with more than a dozen others, sued the administration last summer.
“The personal health care data collected about Medicaid beneficiaries is confidential, to be shared only in narrow circumstances that benefit public health and the integrity of the Medicaid program,” Weiser said when the lawsuit was announced. “There’s no reason to share this sensitive data with immigration or law enforcement agencies. We’re suing to protect Colorado’s Medicaid program and the health and welfare of the people it serves.”
The change could have far-reaching impacts both for patients and families, as well as providers, who are reimbursed by the federal government for caring for Medicaid patients. That included patients who get care through a program called Emergency Medicaid, which covers acute, life-threatening conditions — such as severe injuries, heart attacks, or labor for those who do not meet citizenship or immigration status requirements but meet rules for income and residency. It includes hospital, ambulance, and, in some cases, dialysis services. Hospitals are obligated to provide care during a medical emergency and then are reimbursed for the cost by the federal government.
“It’s Emergency Medicaid, right? So that we’re already thinking of life or death situations,” Ibarra said. “The situation that a lot of our community members are in. We’ve seen people that are deported to their deaths, right? We’ve seen people that are sent to a detention center to die. And so you’re essentially asking the question, should people die in a detention center, should they be deported to their death, or should they seek lifesaving care?”
Ibarra said the dilemma of when and whether to get health care for some immigrants is more than hypothetical. She gave the example of a 7-year-old girl in Oregon, going to a hospital last month seeking treatment for a nosebleed that wouldn’t stop.
Federal agents detained the girl, her mother and father, who are seeking asylum from Venezuela, outside the hospital, according to Oregon news outlet KATU. A lawmaker said the family is now being held at a detention center in Dilley, Texas.
“It’s a devastating situation to be in,” Ibarra said.
The perspective from Denver Health, other hospitals
Other hospital networks also reiterated their stance on patients’ information.
“At UCHealth, we respect the privacy and dignity of every patient, and we do not ask for immigration status. We have not made any changes to how we protect our patients’ health information,” said Kelli Christensen, UCH’s director of public and media relations.
“We understand patients may be concerned by recent reports that ICE can now receive information from the Centers for Medicare and Medicaid Services,” she said. “While we can’t provide legal advice about any patient’s individual situation, we want to assure our patients that we are here to provide the care they need.”
A spokesperson for Children’s Hospital Colorado referred CPR to the Colorado Department of Health Care Policy and Financing as the best source for information about this topic.
“Children’s Hospital Colorado continues to safeguard patient medical information and comply with all state and federal privacy laws, including HIPAA,” the federal act designed to safeguard sensitive health information, said the spokesperson, via email.
“Colorado hospitals are reviewing their policies and may begin to notify patients of this ruling and how CMS shares patients’ personal information with ICE,” said Cara Welch, spokesperson for the Colorado Hospital Association. “Hospitals will continue to care for patients regardless of immigration status. All patients are strongly encouraged to seek care when they need it.”
Ibarra, the immigrant rights advocate, said she thought it was important for the state and health facilities to alert their patients about the change, but handle it with caution.
“I think it’s a double-edged sword,” she said, noting the Denver Health notice, and questions about it, had been circulating on social media for weeks. “With no other context, there’s a lot of room for misinformation to be spread or fear to be spread.”
This story was produced by the Capitol News Alliance, a collaboration between KUNC News, Colorado Public Radio, Rocky Mountain PBS and The Colorado Sun, and shared with Rocky Mountain Community Radio and other news organizations across the state. Funding for the Alliance is provided in part by the Corporation for Public Broadcasting.