Wearing a button pinned to his white jacket that read "Hablo Espanol" (I speak Spanish), he swept into the wood-floored hospital room of one patient and lifted her newborn from a bassinet. "He's big!" Pannill said in nearly accent-free Spanish. "Do you have a name picked out?"

Speaking Spanish is a crucial skill for Pannill, a physician assistant at a medical practice that treats a growing number of pregnant women from Mexico and other Latin American countries. Pannill doesn't ask their immigration status, but he knows that many of them slipped across the border illegally.

As the immigrant population, both illegal and legal, grows in North Carolina and throughout the country, so too does the strain immigrants place on social service providers to make sure their basic needs such as food, housing and education are satisfied. Of all those needs, one of the most costly is health care.

It's difficult to pinpoint the state health-care system's cost of treating illegal immigrants. The main reason is that health-care providers do not ask about immigration status when they treat patients. So they have no accurate way of tallying the costs associated with caring for illegal immigrants.

"People in health care want to stay focused on their jobs, which is to provide care to the sick and injured," said Don Dalton, a spokesman for the N.C. Hospital Association.

He said many providers think asking patients about their immigration status on a routine basis would deter illegal immigrants from seeking needed treatment.

Hospitals, where the most costly care is provided, do measure the costs of treating uninsured patients. Many can track expenses incurred by uninsured Hispanics -- the largest and fastest-growing immigrant group in North Carolina. However, those estimates include medical expenses for citizens and legal residents as well as illegal immigrants.

In a report in January on the economic impact of Hispanic immigration in North Carolina, researchers at the Kenan Institute of Private Enterprise at UNC-Chapel Hill estimated the state's 2004 cost for health services provided to all Hispanics, legal or otherwise, at $299 million. That includes hospitals' uncompensated care -- costs not paid by patients or insurance plans -- as well as costs covered by Medicaid, the joint local-state-federal health insurance program for the poor.

Under federal law, Medicaid pays for care of illegal immigrants only when they have medical conditions that could jeopardize their health or lives.

But a somewhat conflicting federal law requires hospitals to examine -- and if an acute medical problem is found, treat -- anyone who shows up at emergency rooms, regardless of legal status. If an uninsured illegal immigrant receives emergency care and Medicaid does not pay, it is a form of uncompensated care.

Medicaid, unlike hospitals, does try to separately account for illegal-immigrant care. Spending on such care in North Carolina doubled from $25.8 million in 2000 to $52.8 million in 2005, according to the N.C. Division of Medical Assistance, the state's Medicaid manager.

Still, care for illegal immigrants absorbs just a small portion of North Carolina's total Medicaid spending. In fiscal year 2005, the cost of care for illegal immigrants was less than one half of 1 percent of the Medicaid program's total budget of $8.2 billion. Most of the money went to hospitals to cover delivery costs for pregnant women, but Medicaid also paid for ambulances, diagnostic imaging and other emergency care.

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