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Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants - Changes 2013

Views: 34974
Posted: 22 Jun, 2009
by Lisa Sbrana (Legal Aid Society)
Updated: 12 Dec, 2013
by Valerie Bogart (New York Legal Assistance Group)

  1. Enrolling in "Emergency Medicaid for undocumented immigrants and maintaining eligibility should be easier under a new  2013 policy eliminating the form physicians were previously required to fill out -- DOH-4471 form for the Certification of Ttreatment of an Emergency Medical Condition.(revised in 2010)  Immigrants need only submit the standard Medicaid application, and if they are found otherwise eligible, local districts are to issue a Client Benefit Identification Card and authorize coverage for a 12-month period.  For a claim to be paid, the physician must enter an emergency admission type in eMedNY.  Standard spend down and renewal processes apply.  NYS DOH GIS 13-MA-009   http://www.health.ny.gov/health_care/medicaid/publications/gis/13ma009.htm

  1. BUT - Medicaid coverage of prescription drugs for patients with Emergency Medicaid coverage is tightening.  DOH has done a review of claims paid under Emergency Medicaid and determined that the program has been paying for drugs like proton pump inhibitors and blood pressure medications that do not meet the federal definition of emergency care.  A new policy has been announced limiting prescription drug coverage to a list of therapeutic classes associated with emergency care.  Several drugs needed by dialysis patients have been added to the list, but insulin will not be added.  Drugs not on the list will be denied.

Physicians can apply for an override and claims will be paid if the drug is necessary to treat an emergency condition.  Also, NY will continue to pay for chemotherapy using state only funds – but to get payment for oral chemotherapy drugs prescribers will need to submit an over-ride request. 

The list of therapeutic drugs covered under Emergency Medicaid is at this link:  http://www.health.ny.gov/health_care/medicaid/redesign/mrt_phase_3.htm


This article was authored by the Health Law Unit of the Legal Aid Society.

The Legal Aid Society

Attached files
file Emergency Medicaid in New York State 5 _10 Update_100608121108.pdf (33 kb)

Also read
document Immigrant Eligibility for Publicly Funded Health Care Benefits
document Cancer Treatment under Emergency Medicaid

Also listed in
folder Medicaid -> Other Services
folder Immigrant Access

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