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

Views: 37961
Posted: 22 Jun, 2009
by Lisa Sbrana (Legal Aid Society)
Updated: 25 Apr, 2016
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, plus an additional 3-months if retroactive coverage is requested.  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

  2. In January 2016, DOH issued GIS 16 MA/003 - Incarcerated Temporary Non-Immigrants and Undocumented Aliens which states Emergency Services Only coverage will be suspended for incarcerated individuals and reinstated upon release. While incarcerated, Emergency Services Only coverage will pay for the treatment of an inpatient medical emergency condition provided off the grounds of the correctional facility.  For individuals released to the street or parole supervision, Emergency Services Only coverage will be reinstated for a period of five months (beginning on the first day of the release month), but not if released to immigration custody. 

  3. Also in January 2016, DOH issued GIS 16 MA/002 - Changes in Medicaid Coverage for Temporary Non-Immigrants (PDF)  See   Residency Review Worksheet   and Temporary Non-Immigrant Document Types and Visa Codes

  4. 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 Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL Status and Procedure
document The Language Access Resource Center - Empire Justice Center
document Temporary Protected Status (TPS) and Public Health Insurance
document Cancer Treatment under Emergency Medicaid
document Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange

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

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Medicaid for Immigrants who are Not Permanent Residents (Do Not...     The Language Access Resource Center - Empire Justice Center


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