831           EMERGENCY TREATMENT FOR ALIENS

Emergency Treatment for Aliens is a special category of the Medicaid program that provides coverage for aliens who do not meet the Medicaid citizenship requirements. An alien eligible under this special category is not considered to be a regular Medicaid recipient. Coverage is limited to the treatment of emergency medical conditions.

A new application is required for each separate occurrence of an emergency medical condition that requires treatment.

Note:

If an applicant received treatment for multiple events in the same month or in a retroactive month of eligibility, only one application is needed.

Example 1:

John went to the hospital for emergency treatment on 01/05/16 and again on 01/13/16. John can turn in 1 application as the treatment was in the same month.

Example 2:

John went to the hospital for emergency treatment on 01/05/16 and again on 02/08/16. He turned in an application for Emergency Treatment for Aliens on 02/15/16. As the events occurred in the month of application and a retroactive month, only one application is needed.

831 A.      DEFINITIONS

1)  Alien:  For the purposes of Emergency Treatment for Aliens eligibility, an alien is

• a non-qualified alien as defined in section 808-5; or

• a qualified alien as defined in section 808-2 who is subject to the five-year waiting period on Medicaid eligibility.

2)  Covered Dates of Service are the dates in which the alien received treatment for an emergency medical condition and is determined eligible for emergency treatment for aliens.

3)  Emergency Medical Condition means the individual has, after sudden onset, 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.

An emergency medical condition does not include care and services related to either an organ transplant procedure or routine prenatal or postpartum care.

831 B.      ELIGIBILITY REQUIREMENTS

Except as provided in section C, an alien must meet the following requirements to be eligible for the Emergency Treatment for Aliens:

1)  Meet the financial and non-financial eligibility requirements for the category of Medicaid appropriate for the individual;

2)  Be a resident of Alaska;

3)  Meet the definition of an alien; and

4)  Have received treatment for an emergency medical condition.

831 C.      REGULAR MEDICAID RULES THAT DO NOT APPLY TO EMERGENCY TREATMENT OF ALIENS

The following regular Medicaid rules do not apply to an applicant for Emergency Treatment of Aliens:

1)  Medicaid citizenship requirements;

2)  Development of income;

3)  Alien-sponsor deeming (See MAGI MS 820-6 for correct income processing);

4)  Verification of a social security number; or

5)  Verification of immigration/alien status.

831 D.      LIMITED AUTHORIZATION

Once eligibility has been established, the ETEligibility Technician must issue the number of Recipient Identification Cards (coupons) necessary, limiting the authorization to the dates of services identified by the DHCSDivision of Health Care Services. See section 805.

831 E.       COORDINATION WITH THE DIVISION OF HEALTH CARE SERVICES (DHCS)

Because Medicaid coverage for this eligibility category is limited to emergency services, most aliens will apply for emergency medical assistance only after the services have been provided. Hospitals in the state have been instructed to send medical records to the DHCSDivision of Health Care Services office in Anchorage for review. However, there may be times a hospital does not automatically send the medical records and the ETEligibility Technician must assist the individual in obtaining medical documentation to support the emergency medical claim. When assistance is requested, the ETEligibility Technician should request that the hospital submit medical documentation, including the discharge summary to:

Division of Health Care Services

Attention:  Physician Program Manager

4501 Business Park Blvd., Ste 24

Anchorage, AK  99503-7167

DHCSDivision of Health Care Services will:

1)  Determine if the services received were of an emergency nature;

2)  Determine the covered dates of service; and

3)  Provide written authorization to the provider who will then provide a copy of this authorization to the alien.

When an alien applies for emergency treatment, the individual must provide to the ETEligibility Technician a copy of the written approval from DHCSDivision of Health Care Services.

Note:

The letter from DHCSDivision of Health Care Services stating that an individual received services of an emergent nature and indicating which dates of services are covered is not a determination of eligibility. DPADivision of Public Assistance caseworkers must determine eligibility for Emergency Treatment for Aliens based on the criteria outlined in MS 831(B).