Brian Cordones, 13, needs expensive medicine to keep his asthma under control, but his mother can no longer afford it because he has been removed from RIte Care. The Providence Journal / Glenn Osmundson

Ana Beltre watches her 13-year-old son with great anxiety these days, urging him not to run around too much. She fears he’ll set off an asthma attack. That will mean the terror of watching her tall, lean youngster gasp for air as she rushes him to the emergency room.

Her boy, Brian Cordones, had been able to keep his asthma under control with medication. But a couple of weeks ago, Brian lost his health insurance, and Beltre, who works in a jewelry factory, says she cannot afford the drugs he needs.

Brian came to Providence from the Dominican Republic in 2005. He is among some 2,800 immigrant children who were removed from RIte Care, the state-run health plan for poor families, on June 1, as the state reacted to a deficit in the current fiscal year. As the General Assembly considers additional cuts in RIte Care, possibly affecting 1,000 adults in the next fiscal year, these children stand at the leading edge, demonstrating the effects of such changes.

Among the 2,800 already removed from RIte Care, just under half are illegal immigrants. But the other half have the right to be here. And all of them are children.

Some, in fact, are very sick children. Neighborhood Health Plan of Rhode Island, the HMO that cares for about 60 percent of RIte Care enrollees, including 50,000 children, has tallied the number of its patients who were affected by the RIte Care change. Among those dropped from RIte Care are 54 children with asthma, 50 with attention deficit disorder and eight with diabetes. One is in the midst of treatment for bone cancer and has already lost a leg. One needs a ventilator to breathe and is currently living at the state-run Tavares Center. Several have cerebral palsy, Down syndrome, depression or sickle cell anemia.

What will happen to them? “I don’t know,” said Dr. Mack Johnston, the plan’s chief medical officer. “We are kidding ourselves if we think there’s somebody out there, some charitable pots of money, that’s going to pick up the responsibility. … The bottom line is that many will get sicker.”

Most will still get care from the medical practices, health centers and hospitals where they have been patients, which are willing to treat at reduced rates or for free. Acknowledging this added burden, the General Assembly this week is expected to approve $1.2 million in aid to the community health centers that serve the poor and uninsured, and an additional $9 million to help hospitals with uncompensated care.

But youngsters who need expensive medication, medical equipment or physical therapy may have nowhere to turn –– and could end up hospitalized at much greater expense.

“When you realize that this is not a number but a child and a child who’s innocent of their situation, it’s particularly distressing,” said Dr. Robert Burke, a pediatrician with Northstar Pediatrics, which specializes in children with complex medical needs and chronic, disabling illnesses. “Here are people who are around us. Our children go to school with them. They live in our cities. Many have grown up here.”

Among Burke’s patients who lost coverage are two youngsters, ages 12 and 15, who have sickle cell anemia and need expensive, daily medications to keep their red blood cells from curling into the deadly sickle shape. One of them had suffered a stroke brought on by the sickle cell disease, and also needs medications to control the seizures and attention deficit disorder that resulted.

Another patient affected by the change is a child with cerebral palsy who needs physical therapy and braces, and also medication for a seizure disorder.

Burke does not know what will happen to them.

When Governor Carcieri and lawmakers decided to remove these children from the RIte Care rolls, they called it an unfortunate necessity because the state doesn’t have enough money to care for everyone; limited resources, they argued, should be reserved for citizens.

These 2,800 children were targeted 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. The state expects to save $667,000 in the current fiscal year and $4 million next year as a result of removing these children from RIte Care.

But Burke calls it a false economy, because children are going to get sick and come for care anyway. “What do we do with these children? Ignore them? Stand in the doorway and block them from coming in? It’s unrealistic and it’s immoral.” Cutting benefits doesn’t save money, he said, but just changes the route by which the money flows –– and often requires that more be spent.

For example, taxpayer dollars through RIte Care will no longer buy asthma medication for Brian Cordones. As a result, Brian may have an asthma attack and go a hospital emergency department, where he will receive free or discounted care. His emergency visits will cost more than keeping him healthy on medication. Taxpayer dollars and the premiums paid by insured people cover some of this “uncompensated care” at hospitals; the rest comes out of the hospitals’ bottom line, potentially straining nonprofit institutions that everyone depends on.

Dr. Miguel Fuentes, of Mineral Spring Pediatrics, which has offices in Providence and Pawtucket, is worried about a patient with hemophilia who lost RIte Care coverage as a result of the new policy. The boy came from Mexico nine years ago, when he was a baby. To avoid complications, he needs to get a transfusion of a clotting substance, called Factor 8, three times week, at a cost of $3,500 a month. Fuentes will continue to care for him, but he can’t provide the transfusions. Without them, the boy could develop bleeding in his joints that would make it difficult to walk, among other complications.

Susanne Campbell, administrative director of the St. Joseph Center for Health and Human Services, said that her clinic, in Providence, recently received requests to send medical records to other states, suggesting that immigrants are leaving for Massachusetts and elsewhere. The clinic treats about 250 children who were dropped from RIte Care and expects to lose $285,000 as a result.

“We’re encouraging patients to please come and get care,” she said. “We’re trying to be as welcoming as we can.” She noted that her center has a pharmacy assistance program that can help patients who have either a Social Security number or a tax identification number to obtain drugs at a discount from the manufacturer. The center also has a grant to provide free immunizations and a diabetic resource center that can provide insulin.

Ana Beltre, the mother of the 13-year-old with asthma, lives atop two narrow winding stairways in a steamy apartment off Broad Street in Providence. Speaking through a Spanish-language interpreter, she explains that she has RIte Care coverage for herself because she is in the country legally and has been here more than five years. Her 8-year-old daughter has coverage because she was born here and is a citizen. Only Brian –– because he’s been here for less than five years –– is left out in the cold.

She had not heard about the possibility of getting discounted medications from pharmaceutical companies, and it’s not clear whether Brian is eligible for such help.

Only after talking about her predicament for a half-hour does Beltre break into tears. She says she wishes the governor could understand what her family is going through. “We are very close to our children,” she says.

CORRECTION: The second paragraph in this story has been changed.

ffreyer@projo.com