101.02.03 MANDATORY CATEGORICALLY NEEDY – SPECIAL GROUPS

Mandatory Coverage of Certain Aliens for Emergency Services Emergency services, including labor and delivery services, must be provided to aliens who meet all eligibility requirements for Medicaid coverage in any MAGI- related or ABD coverage group except for their alien status who need treatment of an emergency medical condition. Transplant services are prohibited. Coverage is limited to treatment of the emergency condition only. The Division of Medicaid certifies Medicaid coverage for Emergency Services for Aliens. Mandatory Presumptive Eligibility Determined by Qualified Hospitals Qualified hospitals must be allowed to determine presumptive eligibility for individuals eligible for Medicaid in certain Medicaid coverage groups, referred to as Hospital Presumptive Eligibility or HPE. HPE allows qualified hospitals to immediately enroll patients in Medicaid who are determined eligible for Medicaid by authorized hospital staff. HPE provides temporary Medicaid eligibility but also allows access to continuing Medicaid coverage provided the HPE decision includes filing a full Medicaid application. Medicaid coverage groups eligible for HPE decisions include children up to age 19, pregnant women, low-income parents or caretaker relative(s), former foster children and certain women with breast or cervical cancer. The Division of Medicaid is responsible for HPE Medicaid in conjunction with qualified hospitals that certify HPE eligibility. Mandatory Coverage of Refugees Under the Refugee Resettlement Grant Medicaid is provided to certain refugees under a Refugee Resettlement Grant administered by the Department of Child Protection Services (DCPS). Refugees that meet the eligibility requirements for assistance under the grant are eligible for time limited Medicaid. DCPS certifies the eligibility for all qualified refugees that receive assistance and reimburses DOM with funds from the grant for all medical assistance provided by DOM to eligible refugees.