This Manual Release obsoletes Policy Memorandum dated 03/21/03, Emergency Medical Coverage for Noncitizens, Policy Memorandum dated 12/20/04, Emergency Medical Coverage for Noncitizens-Inpatient Hospital Stays and Policy Memorandum dated 09/14/07, Form 3847 Notice to Noncitizen Pregnant Women.
- The definition of emergency medical is redefined.
- Change the term "ineligible noncitizen" to "noncitizen who does not meet the federal qualifying Medicaid criteria".
- Noncitizens who does not meet the federal qualifying Medicaid criteria, age 19 and older, who meet all other factors of eligibility may qualify for emergency medical.
- Proof of pregnancy is not required.
- Emergency medical may be authorized under Family Health Plans (FHPs), ACA Adult, and Aid to the Aged, Blind, and Disabled (AABD).
- Services for an emergency medical condition are limited.
- IES creates an application for Emergency Medical based on answering "Yes" to the question regarding "Special Medicaid Approvals Details" page.
- CAU determines eligibility for emergency medical. Noncitizens with End Stage Renal Disease (ESRD) are excluded from needing a CAU determination for emergency medical.
- A disability or blind determination is required in addition to the emergent need for noncitizen who is determined eligible under the AABD program, unless they are aged 65 or older.
- HFS 3801, Report of Medical Treatment, has been updated. This form must be completed by the attending physician for person applying for emergency medical services.
- HFS 3801 is not required for noncitizens with End Stage Renal Dialysis (ESRD). A physician's statement is sufficient verification.
- A new application is required for each medical emergency occurrence.
- The Notice of Decision (Form 360C) includes a special message for noncitizen pregnant women in the approval notice when immigration documents for the pregnant woman were not provided at the time of application.
- HFS 2378NC, Application for Payment of Emergency Medical Services, is obsolete.
- Go to the IES Resource Library and select the job aid, Emergency Medical Coverage for Noncitizens, for instructions on how to process an application for emergency medical in IES.
- Go to the IES Resource Library and select the job aid, Add/Remove Backdated Medical, for instructions on how to authorize medical backdating.
- HFS 3847, Notice to Noncitizen Pregnant Women, is obsolete.
- Medical Coverage for Noncitizens
- Noncitizen Pregnant Women
- Case Action Required
- Eligibility Requirement
- The Question in ABE that Triggers a Request for Emergency Medical
- Special Medicaid Approval Tab in IES
- Report of Medical Treatment
- How to Create a VCL when Needed for Emergency Medical
- Referral for FHP or ACA Adult
- Referral to CAU for AABD
- How to Upload Documents/Create EDM Tasks for Medical
- Generate a Task for the Client Assessment Unit (CAU)
- CAU Response to FCRC
- Authorizing Emergency Medical in IES (Approve/Cancel)
- Procedure for Authorizing Emergency Medical (Excluding noncitizens with ESRD)
- Acting on CAU Decision
- Eligibility Summary Results
- End Stage Renal Disease
- Authorizing Coverage for Noncitizens with End Stage Renal Dialysis (ESRD)
- Patient with ESRD Requesting Medical Services for a Different Occurrence
- System Changes
- Obsolete Forms
- Manual Revisions
Medical Coverage for Noncitizens
Noncitizens, age 19 and older, who do not meet citizen/immigration criteria, may qualify under the following medical programs:
- Noncitizen pregnant women (PM 06-09); and
- Medicaid Presumptive Eligibility (MPE) (PM 06-10-00); and
- Noncitizens who does not meet the federal qualifying Medicaid criteria.
HFS pays for medical services provided to these persons only if:
- the person meets all other medical assistance eligibility requirements; and
- the services are necessary for the treatment of an emergency medical condition.
Note: Persons who are living in the U.S. temporarily are not eligible for emergency medical because they do not meet the residency. Refer to PM 06-05-01.
Noncitizen Pregnant Women
Accept the applicant's statement regarding pregnancy. Accept the applicant's statement for the number of babies expected. Proof of pregnancy is not required unless there is conflicting information.
When applying for Moms & Babies, pregnant women are not required to provide their Social Security Number (SSN) or proof of immigration because this information is not needed for eligibility. However, some women may actually be able to meet immigration requirements.
Form 3847, Notice to Noncitizen Pregnant Women, is obsolete. A special message is included on Form 360C, Notice of Decision, that advises women whose records do not include SSNs or alien registration numbers to provide their SSN and proof of their immigration status if they have them. By providing this information, the woman may qualify for FamilyCare when their 60 days postpartum coverage ends.
Case Action Required
When the immigration documents are received, review the woman's eligibility for FamilyCare. If she meets citizenship or the immigration requirements, update record with the correct citizenship code and enter her SSN.
If she does not meet immigration requirements, no further action is needed.
A noncitizens who does not meet the federal qualifying Medicaid criteria, may qualify for emergency medical if the individual needs, or have received emergency medical services during the month of application or during the 3 months before the month of application.
Emergency medical services are services required as a result of a medical condition with acute symptoms that are severe enough that, without immediate medical attention, a physician could reasonably expect the condition to result in:
- placing the noncitizen's health in serious jeopardy;
- serious impairments to bodily functions; or
- serious dysfunction of any organ or part.
The acute symptoms can include severe pain, and the medical condition can include labor and delivery.
Note: A new application is required for each medical emergency occurrence.
If an emergency medical condition extends beyond 30 consecutive days, contact the Illinois Department of Healthcare and Family Services (HFS), Bureau of Medical Eligibility and Special Program (BMESP) for guidance.
Eligibility cannot be authorized for a future period. Coverage for an emergency medical condition can only be authorized after the services are provided.
The Question in ABE that Triggers a Request for Emergency Medical
When completing an application in ABE (Application for Benefits Eligibility), the applicant must answer the question, "Is this person a U.S. citizen?" If answered "No", ABE will ask, "Is this a request for emergency medical for a noncitizen. If "Yes", a request for emergency medical for a noncitizen will be processed in IES.
Special Medicaid Approval Tab in IES
To create an application for emergency medical the worker must navigate to the "Questions" page in the Individual Information section. Answer "Yes" to the "Special Medicaid Approvals question".
IES will display the following question: "Does anyone in the case have special Medicaid approvals, Serious Emotional Disturbances or is this a request for emergency medical for a non-citizen?" Select "Yes" to create an application for emergency medical.
Report of Medical Treatment
To assist providers and Department of Human Services (DHS)/Family Community Resource Center (FCRC) in identifying emergency medical conditions, send Report of Medical Treatment (Form 3801) to the applicant's attending physician. The attending physician must specify on Form 3801 the diagnosis or condition requiring treatment, the onset date, and the date the patient was stabilized. Request emergency room notes, test result, discharge summary, medical history, progress notes and previous physical reports.
If the attending physician does not complete HFS 3801 and does not provide all the needed information, deny the application. Reports from nonmedical sources such as billing companies or agents are not acceptable.
Form 3801 must be manually generated by the caseworker. IES will generate a VCL when additional information is required.
The caseworker completes the Client Assessment Unit (CAU) Memorandum (Form 183F) (pdf) as a cover sheet for the CAU packet. Complete the following:
- select type of assessment; and
- select the box "Noncitizen Emergent Medical Need" and
- select the eligibility program for which a determination is needed.
See CAU Checklist for additional guidance.
How to Create a VCL when Needed for Emergency Medical
Caseworker must complete the Disability Details page in order to generate a VCL when additional documentations are needed for a CAU referral.
Also complete the Special Medicaid Approvals - Details page. Complete all the fields on this page except the "Enter the CAU decision" field. Leave that field blank.
Warning: When "Pending" is selected in the "Enter the CAU Decision" field a task is created for CAU.
Although completion of the Disability Details page is required to generate the VCL for emergency medical the Disability Details page must be deleted when approving the case under FHP or ACA Adult. Do not delete the Disability Details page if the applicant is approved under AABD.
Referral for FHP or ACA Adult
Upload the following documents into IES:
- Form 3801 (Report of Medical Treatment);
- doctor's treatment notes;
- test reports;
- hospital records; and
- consultation reports.
Note: Submittal of HFS 3801 alone is not sufficient for CAU to determine whether the person had an emergency medical condition.
Referral to CAU for AABD
A disability or blind determination is required for persons between age 19 and 64, who do not qualify for Family Care, All Kids Assist or Moms and Babies or ACA Adult. If a disability or blind determination is also required, refer to WAG 03-08-01.
Upload Form 183F, Client Assessment Unit (CAU) Memorandum, along with the following documents into IES:
- Form 3801 (Report of Medical Treatment).
- Form 183A and Form 183B (Medical Evaluation);
- progress notes;
- discharge summary;
- test results; and
- any other available medical information pertaining to the persons disability.
How to Upload Documents/Create EDM Tasks for Medical
See Create an IES Inbox Task and Upload a Document. Upload CAU verifications as described below.
||Upload a Document-Do not Create an Inbox Task
|Route to Queue
||CAU Disability Determination Needed
Generate a Task for the Client Assessment Unit (CAU)
To obtain an emergent medical determination, the worker accesses the Disability-Details page in Data Collection and answers the following questions:
- Has documentation been provided for the CAU referral? Enter "Yes" or "No"
- Does the individual require a CAU disability determination? Enter "Yes".
- Enter the CAU decision: Select "pending".
- Run eligibility.
CAU Response to FCRC
CAU sends Form 183C, Medical Evaluation Client Assessment Unit (CAU) Decision, to the FCRC as notification as to whether the person received treatment of an emergency medical condition through IES.
- If CAU determines that the applicant received treatment for an emergency medical condition and the applicant meets all other eligibility requirements, approve the case.
- If CAU determines that the applicant did not receive treatment for an emergency medical condition, deny the application.
IES sets a task for the caseworker to review case.
Authorizing Emergency Medical in IES (Approve/Cancel)
Emergency medical benefits are authorized under the Special Medicaid Approval Detail page.
|Special Medicaid Approvals-Details page
|Circumstance Start Date/Change (CS/CD)
||Beginning date of the approval (first day of the emergency medical condition)
||Emergency Medical Need.
|Approval Begin Date
||Enter the Approval Begin Date (first day of the emergency medical condition) based on the CAU decision.
|Approval End Date
||Approval End Date based on CAU decision (last day of the emergency medical condition) based on the CAU decision.
Applications approved under Emergency Medical for Noncitizens are approved and canceled based on the Approval Begin Date and the Approval End Date entered in IES. Emergency medical cannot be authorized for more than 30 day consecutive days without approval from the Bureau of Medical Eligibility Policy.
Do not authorize coverage beginning on the first day of the month unless the person received emergency services on that date.
Procedure for Authorizing Emergency Medical (Excluding noncitizens with ESRD)
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?
|Approval Begin date
||Date emergency medical began
|Enter CAU decision
||Approved or Denied
|Approval End date
||Date emergency medical ended
|Select Save and Continue.
|Send Notice of Decision (Form 360C).
Eligibility Summary Results
The Eligibility Summary Results page will show as approved for the entire month but MMIS will display the correct beginning and ending dates of coverage.
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 08/01/16 as the Approval Begin Date and 08/01/16 as the End Date.
Example 2: Mr. A, a noncitizen who is a legal permanent resident less than 5 years, is admitted to Adams Hospital on 07/01/17, discharged on 07/05/17. CAU determined he required hospitalization for an emergency condition on 07/01/17. The length of stay to was 4 days. Authorize benefits for 07/01/17 through 07/04/17. Enter 07/01/17 as the Approval Begin Date and 07/04/17 in the Approval End Date.
Example 3: Mrs. A is admitted to Adams Hospital on 06/26/17, discharged on 07/05. 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 as the Approval Begin Date and enter 07/04/17 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 as 14 days. Authorize benefits for 02/01/17 through 02/14/17. Enter 02/01/17 as the Approval Begin Date and enter 02/14/17 as the Approval End Date. Hospital rehabilitation is not covered as a medical emergency.
Go to the IES Resource Library and select the Job Aid, Emergency Medical Coverage for Noncitizens, for instructions on how to process an application for emergency medical in IES.
End Stage Renal Disease
End Stage Renal Disease (ESRD) is considered an emergency condition. Eligibility for noncitizens who do not meet immigration requirements and have ESRD are described in this section. This section does not apply to persons who meet citizenship or immigration requirements. If such persons require treatment for ESRD, treatment may be arranged through the person's primary care physician.
Note: Approval for ESRD only covers dialysis services.
Authorizing Coverage for Noncitizens with End Stage Renal Dialysis (ESRD)
A statement from the attending physician that the noncitizen 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 described below.
|Special Medicaid Approvals-Details page
|Circumstance Start Date/Change
||Enter Date of application
||End Stage Renal Dialysis
|Approval Begin Date
||Enter Date of Application
|Approval End Date
||Leave blank (if approving ongoing benefits)
Patient with ESRD Requesting Medical Services for a Different Occurrence
If a noncitizen receiving ESRD services receives treatment for another emergency medical condition, the client must complete a new application. See PM 02-04-00. The AABD medical EDG for ESRD case remains active. Follow the guidance outlined in WAG 06-05-03.
Example 5: Ms. B, a noncitizen who does not meet immigration requirements, 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.
Medical eligibility for noncitizens who do not meet immigration status is shown in MMIS under the MANG P segment as:
- "NE EMG" for noncitizen not meeting immigration who is eligible for emergency services; or
- "NC RNL" for noncitizen not meeting immigration status who are eligible for renal services only.
- HFS 3847, Notice to Noncitizen Pregnant Women
- HFS 2378NC, Application for Payment of Emergency Medical Services
James T. Dimas
Secretary, Illinois Department of Human Services
Felicia F. Norwood
Director, Healthcare and Family Services