Emergency Medicaid – Overview
Emergency Medicaid is provided for services and care that are required to treat an emergency medical condition; these services are provided to otherwise non-qualified non-immigrants known as “certain aliens” under the statute. These populations and people are often referred to as “non-citizens.” Section 42 of the Federal Code of Regulations, Statute 440.225, identifies services available to certain legalized aliens; these legalized aliens who otherwise meet Medicaid eligibility are eligible for emergency services.
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. With the exception of immigration or citizenship status requirements, individuals must meet Medicaid eligibility status.
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. While not exhaustive, this list can help if you or someone you know is thinking about applying for emergency Medicaid.
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:
- Heart Attack
- Potential loss of limb or eyesight
- Uncontrolled bleeding
- Breathing difficulties
- Severe pain
It is critical to remember that urgent medical conditions that qualify as medical emergencies are defined collaboratively by state policymakers and medical professionals. 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. It is worth noting that most states offer prenatal care to people who qualify for Emergency Medicaid. 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.
In many states, you can apply for traditional Medicaid services for your child after birth. Coordinate with hospital staff to request this 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. Benefits are typically valid for 12 months, but this varies by state. 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.
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.