Report 96117 Summary - October 1997

U.S. Border Patrol:

Its Policies Cause San Diego County Health Care Providers To Incur Millions of Dollars in Unreimbursed Medical Care

Results in Brief

Our review focused on the financial impact to San Diego County health care providers of unreimbursed emergency medical care involving unauthorized immigrants and United States Border Patrol (Border Patrol) agents. We found that health care providers are adversely affected by the Border Patrol's policy to pay the emergency care charges only for those unauthorized immigrants already in its custody at the time of treatment.

We identified 199 incidents between January 1996 and May 1997 involving injured unauthorized immigrants and Border Patrol agents who either arrived at the scene of the injuries at the time, or soon after the injuries were discovered. In all cases, Border Patrol agents had an opportunity to assess whether the injured were unauthorized immigrants and whether to take them into custody—either immediately or following medical treatment. We estimate the total charges in these incidents at approximately $3.1 million, of which the Border Patrol paid approximately $153,100. After deducting these reimbursements plus $8,600 paid from other sources, we estimate that at least $2.9 million went unreimbursed.

Because the Border Patrol would not provide us with a list of incidents requiring medical care, we could not judge the true number of these incidents, although we believe it to be significantly higher than the 199 cases we identified. We estimate the medical charges for these additional incidents could total between $2.0 million and $5.2 million.

Despite its mission to prevent unauthorized immigrants from entering the United States, we found that the Border Patrol's policies may also allow some injured unauthorized immigrants to avoid custody. Because of the Border Patrol's policy that generally provides that it not take the injured into custody, it appears that some individuals—who would likely have been taken into custody immediately had they not been injured—avoid custody as a result of their injuries.

A law effective January 1, 1997, authorizes the federal government to pay for emergency medical services for unauthorized immigrants, whether or not they are in custody at the time of injury. Congress provided $25 million for such payments beginning October 1, 1997. However, the State Department of Health Services did not know, as of September 24, 1997, the portion of the $25 million that California will receive or how much, if any, of that portion it would make available to San Diego County health care providers.


The California Legislature should memorialize to the United States Congress to require the federal government to pay the full costs of emergency medical services when unauthorized immigrants are injured and would have been taken into custody by the Border Patrol were it not for their injuries. Further, if the $25 million allocated by Congress is insufficient to assure California is fully reimbursed for its costs, Congress should increase the appropriation.