PM 06-05-03

New textRefer to the Resource Center to review instructions on how to process an application for Emergency Medical Coverage for Noncitizens. 

Authorizing Emergency Medical (Excluding noncitizens with ESRD)

Revised text

Referral to CAU

  1. Complete and send Medical Evaluation (Form 183F) to the Client Assessment Unit (CAU) Memorandum. Select type of assessment; select the box "Noncitizen Emergent Medical Need" and select the eligibility program for which a determination is needed.
  2. On the Special Medicaid Approvals-Details page enter the following:
  • Individual's name
  • Circumstances Start/Change Date (date of onset);
  • Approval Type;
  • Has documentation been provided for the CAU referral? ;
  • Is CAU decision received?  Enter "No";
  • Approval begin date (leave blank);
  • Enter CAU decision (leave blank); and
  • Approval end date (leave blank).

3.  Select Save and Continue.

Acting on CAU Decision 

After receiving the CAU decision update the following fields; 

Special Medicaid Approvals-Details page
Is CAU decision received? Select "Yes"
Approval Begin date Date emergency medical began
Enter CAU decision Approved, Denied
Approval End date Date emergency medical ended
Select Save and Continue.
Send Notice of Decision (Form 360C).

 New TextNote:  Backdate eligibility for up to 3 months if eligibility existed and there was a medical need.  Do not authorize coverage beginning on the first day of the month unless the person received emergency services on that date.

 Revised textNOTE: Medical eligibility for noncitizens who do does not meet the federal qualifying Medicaid criteria (except for ESRD cases) is shown in MMIS under the MANG P segment as "NE EMG".

Example 1: The application date for Mr. A. is 08/01/16. He received emergency medical services on 08/01/16 for a broken leg. Enter 08/01 in New textApproval Begin Date and 08/02/16 as the Approval End Date.

Example 2: Mr. A is admitted to Adams Hospital on 07/01/17, discharged on 07/05. CAU determined he required hospitalization for an emergency condition on 07/01/17 and reports the length of stay to FCRC for Mr. A as 4 days. Authorize benefits for 07/01/17 through 07/04/17. Enter 07/01/17 in New textApproval Begin Date and 07/04/17 as the Approval End Date.

Example 3: Mrs. A is admitted to Adams Hospital on 06/26/17, discharged on 07/05/17. CAU determined she required hospitalization for an emergency condition on 06/26/17, and reports the length of stay to FCRC for Mrs. A as 10 days. Authorize benefits for 06/26/17 through 07/04/17. Enter 06/26/17 in New TextApproval Begin Date and 07/04 as the Approval End Date.

Example 4: Ms. D. is admitted to Adams Hospital on 02/01, is transferred to the hospital's rehabilitation unit on 02/15/17, and is discharged from the hospital on 02/14/17. CAU determined she required hospitalization for an emergency condition on 02/01/17 and reports the length of stay to FCRC for Ms. D as 14 days. Authorize benefits for 02/01/17 through 02/14/17. Enter 02/01/17 in New textApproval Begin Date and 02/14/17 as the End Date.

The person must reapply when an emergency medical situation, such as a hospitalization, continues beyond the last day of the current processing month.

Authorizing Coverage for Persons with ESRD

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End Stage Renal Dialysis (ESRD) is considered an emergency medical condition. A statement from the attending physician that the person is receiving ESRD services is sufficient. HFS 3801 is not required to approve an ESRD case for renal dialysis services. Do not refer these cases to CAU for a medical determination.

Coverage is limited to renal dialysis services only and the case is approved on an ongoing basis.

Authorize ESRD coverage as follows:

Special Medicaid Approvals-Details page
Circumstance Start Date/Change Enter Date of application
Approval Type End Stage Renal Dialysis
Approval Begin Date Enter Date of Application
Approval End Date Leave blank (if approving ongoing benefits)

Note:  Medical eligibility for ESRD cases is shown in MMIS under the MANG P segment as "NC RNL".

ESRD PATIENT REQUESTING OTHER EMERGENCY MEDICAL SERVICES

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If a person receiving ESRD services receives treatment for another emergency medical condition, the client must complete a new application for medical. Register the new application with a different basic number.  The ESRD case remains active.

  • Send Form 183F, Client Assessment Unit (CAU) Memorandum along with forms 183, 183A, 183B, 3801, and other medical information submitted by the applicant to CAU.
  • If CAU determines that the person received treatment for another emergency condition, authorize emergency medical.

Example 5:  Ms. B, a noncitizens who do does not meet the federal qualifying Medicaid criteria, has an ongoing AABD medical EDG for ESRD. She has an automobile accident on 07/05/15 and receives treatment in the emergency room. She submits an application and a completed HFS 3801. Register the new application to set up a separate case for the emergency medical request. CAU determines that she received treatment for an emergency medical condition. Leave the original AABD medical EDG for ESRD active. Process the new application for this incident. If determined eligible for emergency medical, enter 07/05/15 as the CS/CD and 07/06/15 as the End Date.