2691 Emergency Service Coverage for Non-Citizens

See Policy Memo, PM2000-12-01 (revised 05/01/06), Access to Benefits for Qualifying and Non-qualifying Aliens and Their Families . Non-citizens who are not documented or do not meet the qualifying categories specified in 2140 , may receive medical coverage for an emergency if provided they would otherwise qualify for any Medicaid program (including those found in the Kansas Family Medical Assistance Manual , see 2600), except for alienage status. Persons admitted in the country for temporary purposes, such as foreign students, visitors, tourists and diplomats may meet state residency requirements if they intend to reside within the state. See 2150 .

Eligibility exists under this section only if a person has experienced an approved emergency medical condition. The emergency service must be required after the sudden onset of a medical condition (including labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

Placing the patient's health in serious jeopardy;

Serious impairment to bodily functions; or

Serious dysfunction of any bodily organ or part.

When determining if the emergency criteria are met, an analysis of the medical condition as well as the location in which treatment was provided are completed. Only the SOBRA program manager at KDHE-DHCF or designated fiscal agent staff may determine if an allowable emergency has occurred. The MS-2156 , Medical Review of Emergency Services for SOBRA form, shall be used to capture information pertaining to the condition in order to make this determination. The MS-2156 and required supporting documentation, obtained from the provider shall be sent to the fiscal agent for a decision. An MS-2156 that is received from the provider must be submitted to the Fiscal Agent/SOBRA Program Manager for every alleged emergency, except labor and delivery. For women requesting assistance only for labor and delivery, eligibility may be determined without an MS-2156 .

Payment for services other than labor and delivery requires a completed MS-2156 with information regarding the medical reason for the services. Where an MS-2156 is required, action to approve or deny eligibility is not taken until a medical determination is rendered. An MS-2156 is not required for persons who fail to meet other eligibility criteria. Eligibility can be granted for more than one emergency. Coverage is limited for individuals eligible under the SOBRA coverage group to only the emergency service. No other services shall be covered.

NOTE : If a subsequent emergency occurs, a new MS-2156 must be obtained and evaluated as described above. It must be sent to the fiscal agent for review as well. This is true even if the emergencies occur in the same month.

The general eligibility requirements of 2100 and subsections must be met except for the SSN requirements of 2130 and the alienage provisions of 2140 . In addition, eligibility shall be based on the appropriate medical program (e.g., poverty level for children and pregnant woman meeting poverty guidelines, Medically Needy for dependent children, Spenddown for disabled persons, Family Medical, etc.). Although coverage is restricted to meeting a specific emergency and no further ongoing medical eligibility will be permitted, eligibility shall be determined under normal procedures including the appropriate base period rules. See 7330 . In addition, the spenddown provisions of 7530(2) are also applicable except for poverty level eligibles. Care must be taken to ensure eligibility is properly displayed in MMIS.

The case is to be closed as rapidly as possible due to the time-limited nature of the coverage and is not to remain open through the entire base period. Should eligibility be determined under a 6-months base period and the client again requires emergency services later in that base period, eligibility is to be redetermined using the same 6-months base period. If spenddown was met with the previous emergency and there are no other changes in circumstances, the client would be eligible.