I wanted to touch on a topic that I’ve always wanted to learn more about: Emergency Medicaid. As ER docs, I think it’s important to know what resources we have available for our patients.
Some of this varies by state, so I would recommend quickly familiarizing yourself with the state guidelines. The information provided below is specific to New York state.
What is Emergency Medicaid?
The federal government requires each state to provide Medicaid coverage for the “care and services necessary for the treatment of an emergency medical condition.”
What services are considered “emergency?”
“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.”
Cancer treatment: chemotherapy, radiation treatment, prescription medications
Emergency surgeries (not elective)
Emergency L&D services
So who’s eligible for Emergency Medicaid?
Undocumented immigrants may apply for Emergency Medicaid.
There are four criteria for Emergency Medicaid eligibility:
The patient is a district resident
The patient has an emergency medical condition
The patient meets income requirements
The patient is not eligible for ongoing Medicaid due to their citizenship or immigration status
For New York Medicaid (not *emergency* Medicaid), here is the criteria for eligibility. As you can see, it doesn’t capture a lot of our patient population. The patient must be:
NY resident / US citizen, and
Pregnant, or
Be responsible for a child </=18 years old, or
Blind, or
Have a disability or a family member in the household with a disability, or
65+ years old
Some conditions require you to fall below certain income thresholds:
Have a household income (before taxes) that is below 138% of the federal poverty level. For reference, this translates to:
1 member household: <$17,131
2 member household: <$23,169
3 member household: <$29,207
4 member household: <$35,245
How do I help my patient sign up for it?
Our social work and case management teams are very helpful in facilitating this process. https://nystateofhealth.ny.gov/
How long does it last for?
If Emergency Medicaid is approved, it will cover future and past costs associated with the medical condition for a maximum of fifteen months.
Retroactive coverage maximum: 3 months
Prospective coverage maximum: 12 months
It can last for up to twelve months or as long as the person is experiencing the emergency, whichever is shorter.
Misc:
Emergency Medicaid does not affect someone’s ability to apply for legal status
This is not reported to US Immigration & Customs Enforcement.
References:
http://www.wnylc.com/health/entry/70/
https://www1.nyc.gov/assets/ochia/downloads/pdf/fly-957-emergency-medicaid-english.pdf
https://dhcf.dc.gov/service/emergency-medicaid
https://www.benefits.gov/benefit/1637 https://www.health.ny.gov/health_care/medicaid/emergency_medical_condition_faq.htm