576           EMERGENCY TREATMENT FOR ALIENS

Emergency Treatment for Aliens isIndividualized Supports 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.

576 A.      DEFINITIONS

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

• a non-qualified alien as defined in APA Manual Section 421-6; or
   
• a qualified alien as defined in APA Manual Section 421-2 who is subject to the five-year bar 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.

576 B.      ELIGIBILITY REQUIREMENTS

Except as provided in Subsection C, an alien must meet the following requirement to be eligible for the Emergency Treatment of 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.

576 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;
    
4. Verification of a social security number; or
    
5. Verification of immigration/alien status.
    

576 D.      LIMITED AUTHORIZATION

Once eligibility has been established, the caseworker must issue the number of Recipient Identification Cards (coupons) necessary, limiting the authorization to the dates of services identified by the Division of Health Care Services.  See Section 501.

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

576 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 caseworker must assist the individual in obtaining medical documentation to support the emergency medical claim. When assistance is requested, the caseworker should request that the hospital submit medical documentation, including the discharge summary to:

Division of Health Care Services

Operations

Attention:  Carrie Crouse

4601 Business Park Blvd., Bldg. K

Anchorage, AK  99503

Fax: (907) 770-1684

The Division 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, they must provide to their caseworker 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 the covered dates of service 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 ADLTC 576(B).