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Feds stiff Arizona border town for ambulance costs for immigrants

NOGALES, Ariz. — Many communities across the U.S. have problems getting reimbursed for sending ambulances to pick up patients, but for one community along the U.S.-Mexico border, the delinquent party is the federal government, which the city of Nogales says owes it hundreds of thousands of dollars for picking up immigrants.

The Arizona city billed the federal government for hundreds of ambulance sorties dispatched to calls from federal agents when they find someone injured, but the government has paid less than 20 cents on the dollar — leaving Nogales to bear the burden of more than $250,000 in the past fiscal year alone.

"We would love to be reimbursed 100 percent. If we were to be reimbursed 100 percent, we could provide a higher level of service to our residents in Nogales," said Aaron White, the city's acting finance director.

Nogales, with a population of about 20,000 about 60 miles south of Tucson, offers a vibrant shopping district that fans out from the official vehicle and pedestrian border crossings. The stores, with their clothing, home goods and cheap children's toys, cater to the 200,000 Mexicans who live a few feet away in Nogales, part of the Mexican state of Sonora.

That proximity also makes it a natural point for border-jumpers, which means federal customs, immigration and drug agents have a heavy presence as well. When injuries occur, it's the city's rescue service that responds.

During the 2012-13 fiscal year, the city says, it responded to 248 calls and billed the federal government $300,058 but recouped just $47,740, according to figures obtained by the Nogales International newspaper and confirmed by city officials.

The previous year, the city billed $277,382 for 230 calls and was reimbursed just $29,919.

It isn't clear why Nogales isn't being fully reimbursed.

Part of the 2003 law that added a prescription drug program into Medicare also created a pot of money to reimburse municipalities for uncompensated care of illegal immigrants, including ambulance calls.

The money — $250 million a year from 2005 through 2008 — was divided among states, to remain available until it was expended. Some states have exhausted all of their designated funding, but Arizona still had more than $13 million at the beginning of 2013.

U.S. Immigration and Customs Enforcement didn't return messages seeking comment about the program.

The Centers for Medicare and Medicaid Services, which maintains the spending data, wouldn't speak on the record and said it couldn't speak specifically to why Nogales was being reimbursed only 20 cents on the dollar.

CMS said any move to replenish the fund for all the states would have to be made by Congress.

Nogales' fire department doesn't keep track of whether the calls stem from injuries from someone trying to jump the border fence, from a car accident or from some other cause. The Nogales International reported that after the federal government doubled the height of the border fence in the city, ambulance calls spiked — though they eventually dropped to near their original level.

David Austin, an aide to the Border County Coalition, a group of officials from jurisdictions along the U.S.-Mexico border, said unreimbursed care "remains a significant problem." The coalition helped push the original money, which was championed by Jon Kyl, an Arizona Republican serving in the Senate at the time.

"However, the program authorization expired and most states have exhausted their available funds. To date, no one has championed a reauthorization," Mr. Austin said.

Nogales officials took umbrage to having this kind of attention called to their city.

"One of our main concerns is that national media picks up on Nogales and all of a sudden it turns negative, rather than the positives of life living here," Mr. White said.

Deputy City Manager John E. Kissinger said the city simply considers the uncompensated funds to be bad debt, just like if any other patient didn't pay the bill from an ambulance call.

"If you strip it down to its basic and its logic, you can probably anticipate this type of debt. Now, if you want to make a bigger immigration story, you're speaking to the wrong person," he said.

"Sometimes you read some of these stories, what we're talking is, 'Well, if the undocumented immigrants weren't in the U.S., we wouldn't have that cost,'" he said. "But that's not what we're here about. The city of Nogales is here to provide the best emergency response as we can."

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