What is Emergency Medicaid? - Grants for Medical

Emergency Medicaid – Overview

Emergency Medicaid is provided for services and care required to treat an emergency medical condition for individuals, including certain non-citizens and undocumented immigrants, who would otherwise not qualify for regular Medicaid. These populations and people are often referred to as “non-citizens.” Section 42 of the Code of Federal Regulations, specifically 42 CFR 435.139, describes emergency Medicaid eligibility for certain non-citizens, including those without legal permanent resident status, who meet other Medicaid eligibility requirements.

Emergency services are defined as those that, in the absence of immediate medical attention, could put the patient’s health in jeopardy, seriously impair bodily function, or seriously dysfunction any bodily organ or part.

Emergency Medicaid is intended for use in the short term to meet a specific medical need. Emergency Medicaid is a vital financial lifeline for eligible families and individuals in the midst of a medical emergency.

Who is Eligible for Emergency Medicaid

Although eligibility for emergency Medicaid may differ slightly from state to state, a number of key tenants exist due to existing federal legislation. Individuals must meet the general Medicaid eligibility criteria in their state, except for immigration or citizenship status, to qualify for Emergency Medicaid.

Individuals without current legal immigration status, non-immigrant visa holders, those with temporary protected status, and Deferred Action for Childhood Arrivals (DACA) recipients may fall into this category. This list provides examples of individuals who may qualify for Emergency Medicaid due to their immigration status; however, eligibility will depend on specific state regulations.

What is Considered an Urgent Medical Condition that Qualifies for Emergency Medicaid

As previously defined, emergency services are those that, in the absence of immediate medical attention, could result in the patient’s health being jeopardized, serious impairment of bodily function, or serious dysfunction of any bodily organ or part. Examples of this may include, but are not limited to:

Appendicitis
Heart Attack
Stroke
Potential loss of limb or eyesight
Self-harm
Uncontrolled bleeding
Breathing difficulties
Severe pain

Emergency medical conditions qualifying for Emergency Medicaid are defined under federal law as conditions manifesting acute symptoms of sufficient severity 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. While most states’ policies are likely comparable, states may have limited ability to classify an urgent condition as a non-emergency and thus refuse to cover a specific condition under Emergency Medicaid.

What are the Healthcare Services Not Covered Under Emergency Medicaid

Non-emergency medical episodes or events are not covered by Emergency Medicaid. Treatment for non-emergency chronic disease or illness, specialty services such as optometry or physical therapy contingent on the non-emergency nature of the request, and routine treatment services are examples of these. It is important to note that organ transplants are not covered under Emergency Medicaid.

How Can Emergency Medicaid Provide Benefits During Pregnancy, Labor, and Delivery

Prenatal care is frequently not covered by Emergency Medicaid. Emergency Medicaid generally does not cover prenatal care except under circumstances where the pregnancy itself causes an emergency condition; however, some states provide pregnancy-related services under different programs for undocumented immigrants. These programs frequently provide prenatal care, consultation, and services regardless of the mother’s immigration status.

While this information is not directly related to Emergency Medicaid and its relationship to providing labor and delivery services, it is necessary to include it so that our populations are aware that while there is a lack of services in many instances, some services are available to provide additional supports to undocumented persons prior to labor and delivery.

In most states, you may apply prior to labor, during admission for labor and delivery, or after delivery. You can commonly apply at the hospital, where hospitals are likely to have staff able to assist with the application process.

If you apply on your own after the birth of the child, you will most likely be asked to provide medical documentation, such as the discharge summary for the mother and child. It is important to keep this documentation, as it may be the primary qualifying documentation available to secure Emergency Medicaid benefits.

Children born in the United States to mothers covered by Emergency Medicaid during delivery are generally eligible for regular Medicaid as citizens, regardless of the mother’s immigration status. Coordinate with hospital staff to make this a possibility.

How long do Emergency Medicaid benefits last

Benefits can be provided retroactively for up to three months in most states. Benefits will be paid upon completion of treatment in accordance with the approved benefit application. Emergency Medicaid benefits are provided only for the duration of the emergency. The state will determine eligibility at the frequency determined by the state.

Individuals eligible for Emergency Medicaid are expected to comply with state reporting requirements such as resident status, income verification, and medical treatment plan updates. Please keep in mind that, as previously stated, Emergency Medicaid does not consider legal resident status; however, moving outside of the state where Emergency Medicaid has been approved may limit, reduce, or eliminate eligibility.

Conclusion

Emergency Medicaid can be a lifeline for families and individuals who meet the eligibility requirements of their respective states. Because emergency needs are frequently unexpected, this financial lifeline can play an important role in ensuring that a medical emergency does not devastate a family’s or individual’s finances while providing the necessary treatment to recover.