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OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS UNDOCUMENTED/ILLEGAL ALIENS
TREATMENT OF AN EMERGENCY MEDICAL CONDITION
The DOH-4471 form has space to accommodate up to four coverage periods (From-To Date(s) of Treatment/Hospital Stay). Each “From- To” date(s) must be entered in the Welfare Management System (WMS) as a separate coverage period, and each coverage period requires a separate Client Notification System (CMS) note (upstate). For any subsequent treatment/hospital stay or continuing treatment for an emergency medical condition, a new DOH-4471, form must be completed, dated, and signed by the A/R, or the A/R’s authorized representative, and by the treating physician.
The maximum period of time for which “emergency treatment” (coverage code “07”) may be entered from one submission of the DOH-4471 is 90 days. This can be a combination of retroactive, current, and prospective coverage. A new DOH-4471 must be obtained from a physician at least once 90 days, in order to continue the Medicaid coverage. Future (prospective) coverage may not exceed 60 days.
Category 5: Undocumented Aliens
Category
Documentation WMS ACI code
Federal Financial Participation (FFP) Social Security Number (SSN) Requirement Undocumented Aliens: (Undocumented aliens do not have the permission of the USCIS to remain in the U.S. They may have entered the United States legally but have violated the terms of their status, e.g. over-stayed a visa, or they may have entered without documents.) Undocumented aliens are unable to provide documentation of immigration status; therefore, absent any documentation they are eligible only for the treatment of an emergency medical condition. Undocumented children may be eligible for CHPlus. Undocumented pregnant women continue to be eligible for pre-natal care.
E Only eligible for treatment of an emergency medical condition
YES
NOT Required
MRG