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Cancer Treatment under Emergency Medicaid
Local social service districts in New York have been directed by the State Department of Health to provide coverage under the Emergency Medicaid program for chemotherapy and radiation treatment associated with a cancer diagnosis. Coverage should include prescription medications as long as they are associated with stabilization and treatment of the diagnosis that constituted the medical emergency. If you need to provide authority to a local district for coverage of cancer treatments, use administrative guidance, General Informational System 07 MA 017.
Remember that to qualify for Emergency Medicaid, clients need to be residents of New York State, financially eligible for Medicaid, and the condition requiring treatment needs to manifest itself by acute symptoms (including pain) such that absence of immediate medical attention could put the patient in serious jeopardy, seriously impair bodily functions or cause serious dysfunction to an organ or body part.
In addition to completing the Medicaid application form to demonstrate financial eligibility for the program, clients will need to have their attending physician certify an emergency medical condition on a form specifically developed for the Emergency Medicaid program. The form is attached to administrative guidance, General Information System 10 MA 012.
Each form covers a maximum of 90 days of treatment -- with services covered retroactively for 30 days and up to 60 days prospectively. Physicians must submit a new form to cover additional periods of treatment.
Certain services are specifically excluded from Emergency Medicaid coverage, including: organ transplants, nursing facility services, home care services, hospital stays billed as "alternate level of care," and rehabilitation services (PT, OT and Speech therapy).
This article was authored by the Empire Justice Center.