5600           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.

 

5600 A.      DEFINITIONS

 

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

 

 

 

  1. 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.

 

  1. 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:

 

 

 

 

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

 

5600 B.      ELIGIBILITY REQUIREMENTS

 

Except as provided in Subsection 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;

 

  1. Be a resident of Alaska;

 

  1. Meet the definition of an alien; and

 

  1. Have received treatment for an emergency medical condition.

 

5600 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;

 

  1. Development of income;

 

  1. Alien-sponsor deeming;

 

  1. Verification of a social security number; or

 

  1. Verification of immigration/alien status.

 

5600 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 5075.

 

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

 

5600 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 DHCS 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

Attention:  Physician Program Manager
4501 Business Park Blvd., Ste 24

Anchorage, AK  99503-7167

 

The Division of Health Care Services will:

 

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

 

  1. Determine the covered dates of service; and

 

  1. 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 DHCS.

 

5600 F.      EIS Eligibility Information System INFORMATION

 

EIS INFORMATION: EMERGENCY TREATMENT

MEDICAID SUBTYPE:

AL

Ineligible alien (FM related)

IL

Ineligible alien (SSI/APA related)

ELIGIBILITY CODE:

11

Pregnant Woman

53

 Ineligible alien emergency coverage   (used for every one except pregnant women)

 

 

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MC #35 (09/07))