Mariana Narbaez, 12, of Central Falls, who suffers from hearing loss, is one of the estimated 2,800 immigrant children cut from the state’s health-care program as of June 1.

The Providence Journal / Steve Szydlowski

Facing a severe budget hole, Governor Carcieri pitched an idea this spring he knew wouldn’t be popular among the Democrat-dominated General Assembly.

The Republican governor said he could save taxpayers $4 million by cutting health-care coverage from more than 2,800 immigrant children –– many of whom were living in Rhode Island legally.

The Assembly ultimately went along with the plan, but later tried to soften the blow. Lawmakers slipped $1.2 million into the new state budget to ensure the children qualified for primary-care coverage –– amounting in most cases to basic checkups –– at community health centers.

But more than a week after the new budget became law, the health centers haven’t seen a dime of the new funding. The children’s families don’t know they qualify for any coverage at all. And the state has no immediate plans to notify them.

Twelve-year-old Mariana Narbaez is among the children who lost health insurance in recent weeks.

Her grandmother said yesterday she didn’t know the girl could visit community health centers at no cost. Having received a letter from the state terminating her granddaughter’s insurance, the family thought it was on its own.

And that presents a unique problem for the Central Falls middle-schooler. Mariana, who came to Rhode Island three years ago from Colombia, needs medical help.

“If not cared for by the proper specialists, she could lose her hearing,” said her grandmother, Maritza Narbaez, a United States citizen. “In this moment of crisis, we don’t know what to do.”

Mariana, who is in the United States legally under a resident visa, suffers from a degenerative hearing condition.

She is scheduled to meet with a hearing specialist in November, as required every six months. But Maritza said her family would probably cancel the appointment, which is too expensive without insurance.

The specialists, any medication, and the hearing aids aren’t covered under the reduced plan offered by the health centers.

NO ONE WANTED to cut health-care coverage for children, according to the governor’s spokeswoman Amy Kempe.

“It was an extremely difficult budget year,” she said.

The state Department of Health is charged with distributing the $1.2 million to community health centers, which are spread across the state.

Health Director Dr. David R. Gifford said the money would likely be distributed proportionally, based on the number of children served by the health centers. Further, the Department of Health is developing oversight standards to ensure the money is spent to care for the children and not to cover administrative costs.

Gifford declined to put a time-table on when the funding would be distributed.

“It’s not going to take months and months,” he said, acknowledging that many health centers have been serving children at no cost for more than a month.

The Providence Community Health Centers, which operates five primary-care facilities around the city, has been treating the children as if they still had RIte Care coverage, anticipating a payment from the state, according to CEO Merrill Thomas.

“We’ve committed to taking care of them for now,” he said. “We don’t want them not to get their shots. But each health center is on [its] own.”

There is no blanket order requiring health centers around the state to offer free health-care coverage to the children. The centers already offer discounted care to uninsured Rhode Islanders, based on their ability to pay.

And while the Providence centers offer free doctor’s visits for the immigrant children cut from RIte Care, that’s where the coverage ends.

“We don’t pay for the lab and the x-ray and the specialist,” Thomas said. “If I send them to the drug store to get something, they’re not going to have coverage.”

But it’s unclear if that information is being passed on to the families of the immigrant children.

State officials in May notified them that they would lose subsidized health insurance. But the state has yet to inform them of the health-center option.

Notification “would have been through the health centers,” said Gary Alexander, director of the Department of Human Services, which issued the cancellation notices to families.

Meanwhile, the health-care system will likely absorb the cost of Rhode Island’s uninsured, a figure previously estimated at 120,000 people.

Many get care from the medical practices, health centers and hospitals where they had been patients, which are willing to treat at reduced rates or for free. And hospitals are required to provide free care for individuals earning less than 200 percent of the federal poverty level, Gifford said.

Alexander acknowledged that some hospitals may try to seek payment for services, “but the bottom line is they have a duty to care for the patient,” he said.

Because of the expected burden, the General Assembly approved another $9 million to help hospitals with uncompensated care, in addition to the $1.2 million they approved for health centers.

The 2,800 children were targeted in part because their care had been paid 100 percent by the state. The federal government reimburses for more than half of most RIte Care costs, but it does not cover care for noncitizens who have been in the country for less than five years or for those who are here illegally.

Meanwhile, the Narbaez family worries about the health of the immigrant community.

“There are children in worse condition than Mariana,” Maritza Narbaez said. “We are under attack.”

speoples@projo.com