The Jackson Health System in Miami’s Dade County has stopped paying for kidney dialysis for indigent patients. The move affects 175 kidney patients who have depended on the county hospitals to provide their life-saving treatments.

With this measure, the public hospital system, tasked with providing health care for the uninsured and the poor, is expecting to save $4.2 million of a projected $168 million budget shortfall this fiscal year.

Hospital spokespersons claim that most patients will be able to obtain treatment by going to emergency rooms. This will effectively shift the cost of dialysis from the county to the federal government, which provides emergency Medicaid payments for dialysis treatments performed in emergency rooms.

Under federal law, emergency rooms must provide treatment for patients in serious medical need. In order to get emergency room treatment however, patients must be in severe medical distress.

The St. Petersburg Times quotes Emelina Cordovi, 67, whose treatments at a South Miami Dade center were cut off December 31. “It is no game,” she told the newspaper. “We are talking of the lives of persons who depend exclusively on their dialysis.”

This action follows the precedent of Grady Memorial Hospital in Atlanta, Georgia last October. Grady closed down its outpatient dialysis clinic, also to cut costs.

The federal government does not provide Medicaid or Medicare funds for undocumented immigrants, who make up a significant portion of dialysis patients. At Grady Hospital in Atlanta, most of the affected patients were undocumented immigrants. The hospital arranged for 10 of them to return to their home countries and paid for dialysis treatments for three months. About 50 of the patients are left in Atlanta and have been granted payment for dialysis at commercial clinics until February.

After that, they are on their own.

As impurities build up in the blood due to kidney failure, those missing dialysis treatments and waiting to get sick before going to the emergency room could be subject to heart inflammation, nerve damage and other problems. The St. Petersburg Times quotes Raul de Velasco, a Miami Dade nephrologist who serves on several local ethics panels, as saying, “They will not die quickly or suddenly—but they will die a slow death.”