400.09 EMERGENCY MEDICAL SERVICES FOR IMMIGRANTS – COE-021

Non-qualified aliens or immigrants who meet all eligibility requirements except citizenship/alien status are entitled to Medicaid for the treatment of an emergency medical condition only. Refer to Chapter 102, Non-Financial Requirements, and the discussion of Non-Qualified Aliens in 102.05.11 for policy regarding who is eligible for consideration of Medicaid emergency medical services and who is not. An immigrant under consideration for Medicaid emergency medical services must be determined eligible under an available Medicaid COE and meet all eligibility factors other than citizenship, immigration status and furnishing an SSN. This means the immigrant must be: • Aged, blind or disabled and meet the criteria for coverage in an ABD coverage group, or • A child under age 19 eligible in a MAGI-related Medicaid COE (not CHIP). • A pregnant woman who otherwise meets the MAGI requirements for COE-088 coverage, or • A parent or caretaker relative who otherwise meets the MAGI requirements for coverage in COE-075. Emergency Medicaid medical services are approved for the date the emergency services were provided, so the authorization of emergency medical services is always “after the fact,” or after the emergency has occurred. Emergency Medicaid for immigrants includes: • Labor and delivery services provided to an immigrant determined to meet the qualifications for coverage as a pregnant woman. • Services provided to an immigrant that, after sudden onset, results in a medical condition 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: o Placing the patient’s health in serious jeopardy, o Serious impairment to bodily functions, or o Serious dysfunction of any bodily organ or part. Emergency Medicaid for immigrants does not include an organ transplant or routine prenatal or postpartum care. Central Office and Regional Office staff share the duty of authorizing emergency Medicaid to immigrants who qualify for emergency medical services. • Regional Offices accept, process and authorize applications for emergency medical services for immigrants requiring emergency labor and delivery services. • Regional Offices accept applications and determine the financial and non- financial eligibility for all other COE’s, but the final determination of eligibility is made by Central Office staff who approves or denies eligibility for the immigrant based on documentation of the emergency medical condition. Central Office staff utilizes the medical expertise of medical staff working for DOM in determining if emergency medical services are warranted. The immigrant does not receive a Medicaid card, but appropriate notices of approval or denial are issued to the immigrant. Providers of the emergency medical service are notified of all Medicaid approvals of emergency medical services so that Medicaid can be billed for the emergency services.