Processing the application

Review the individual's immigration status to ensure they are not eligible for any other MAGI programs. AEM is a program of last resort and only available to the following: Undocumented individuals; Qualified aliens who have not met the 5-year bar and are not exempt from the 5-year bar; and Nonpregnant nonqualified aliens

Is the individual seeking or receiving long-term care services? If yes, refer to the Aging and Long-Term Support Administration (ALTSA). Send an email to Emily Watts at HCS indicating the name, client ID, type of LTC services needed, and dates services are needed. Continue processing the AEM request for medical assistance pending the result of the ALTSA prior authorization request. The HCS program manager will ensure the LTC request is followed up on if a slot is approved on the state-funded program. There is no need to forward documents in DMS to HCS or to the LTC Specialty Team If no, continue processing.

Complete the AEM referral/checklist in barcode as follows: If not already provided, send a request for information letter HCA 12-361 to the individual for required documents on referral/checklist. If the individual is still hospitalized at time of application and after contact with the hospital, the discharge date cannot be determined, refer to HCA medical consultant with the following: Admission history and physical (signed by the admission doctor); The most recent physician notes; and Note from the worker that the individual is still inpatient. Once all documents are provided, forward the referral/checklist and documents to the HCA medical consultant through the Barcode AEM Referral system. AEM applications cannot be approved until the HCA medical consultant has approved the AEM referral. The HCA medical consultant can be contacted at: Health Care Authority Health Care Benefits and Utilization Management MS 45506 Telephone: 800-562-3022 FAX: 360-586-1471 All communication pertaining to an AEM referral should be made through the Barcode AEM Referral system.

Once the AEM referral is returned by the medical consultant, follow these steps on processing the referral. Approval and denial letters must be manually generated out of the Washington Healthplanfinder. Add the following free-from text to approval letters: (Individual's name) has been approved Washington Apple Health, Alien Emergency Medical from (date) to (date). Add the following WAC and free-form text to denial letters: WAC 182-507-0110 - We have reviewed your case and you are not eligible for any HCA/DSHS medical program. We also reviewed your eligibility for the Alien Emergency Medical program and you do not meet the following: Have not had surgery to treat cancer, and are not receiving chemotherapy and/or radiation therapy to treat cancer; or Are not immediately starting or receiving dialysis to treat acute renal failure or end-stage renal disease; or Are not receiving antirejection medication for a post organ transplant. Do not have a qualifying emergency condition

ACES Online calculates the certification period.

If an AEM application is denied without having to make a referral to the HCA medical consultant, force close the application in the Washington Healthplanfinder with a 535 code and add the following WAC and free-form text: WAC 182-507-0110 We have reviewed your case and you are not eligible for any HCA/DSHS medical program. We also reviewed your eligibility for the Alien Medical program and you do not meet the following: Have not had surgery to treat cancer, and are not receiving chemotherapy and/or radiation therapy to treat cancer; or Are not immediately starting or receiving dialysis to treat acute renal failure or end-stage renal disease; or Are not receiving antirejection medication for a post organ transplant. Do not have a qualifying emergency condition