Emergency MO HealthNet Care for Ineligible Aliens provides coverage for emergency medical care of aliens who meet all eligibility requirements for a federally funded MO HealthNet program except citizenship/alien status. Ineligible aliens are eligible only for the dates of the emergency medical care.
Section 1903 (v) of the Social Security Act provides MO HealthNet (MHN) coverage for emergency care to ineligible aliens
To qualify, the applicants must meet all eligibility requirements for a federally funded MO HealthNet program except citizenship/alien status, and meet the additional eligibility factors listed below.
NOTE: Residence is a requirement of all federally funded MO HealthNet programs and must be met as a part of eligibility for the federally funded program. Residence is not exempted as part of the Ineligible Alien Status. Individuals admitted as tourists or visitors and in the United States as tourists or visitors are not eligible as they would not meet the residence requirements.
Ineligible Alien Status includes those aliens who meet the following requirements:
EXCEPTION: Undocumented aliens are not required to provide or apply for a Social Security Number.
An emergency medical condition must exist or have existed in the month of application, or in one of the prior quarter months. The individual does not have to enter the hospital or medical facility via an emergency room to qualify. An emergency medical condition is defined as follows:
Labor and delivery excludes pre- and post-partum care. Refer individuals who need prenatal care to Temporary MO HealthNet during Pregnancy (TEMP) qualified provider to apply for TEMP.
Medical documentation is required for all emergency conditions except for standard labor and delivery. Documentation should include the EMCIA cover sheet (IM-365) medical records, signed releases for medical records, and any other information pertaining to the medical condition that is available. The Medical Review Team (MRT) will make the determination if the medical event qualifies as an emergency medical condition, except for standard labor and delivery. See procedures based on program in Income Maintenance Manual section 1700.020.00 Ineligible Alien Status.
An ineligible alien must apply for an existing federally funded MO HealthNet program. Determine eligibility for the appropriate federally funded program on all factors including residence, and excluding citizenship/alien status. Exclude undocumented aliens from the Social Security Number requirement.
When an ineligible alien makes an application for EMCIA, enter the application request for the appropriate federally funded MO HealthNet program. The application request must be entered after the emergency medical or labor/delivery event has occurred and within prior quarter time frames. Determine eligibility based on the MO HealthNet program's requirements, excluding citizenship/alien status. MO HealthNet based on Permanent and Total Disability must have disability established through the normal Medical Review Team (MRT) process.
The eligibility factor of emergency medical condition will be determined by the MRT. The MRT will evaluate the medical records and determine if the criteria for an emergency medical condition has been met on each day that coverage is requested.
If an applicant is ineligible for a reason other than citizenship/alien status (such as income, financial resources, intent to remain), reject the application on citizenship/alien status and any other factor of ineligibility. Do not send medical records or signed releases for medical records to the Medical Review team for determination of an emergency medical condition when an applicant is ineligible for a reason other than citizenship.
NOTE: MO HealthNet for Kids premium cases will not be eligible for EMCIA because the request for Emergency MO HealthNet Care for Ineligible Aliens must be made after the emergency medical or labor/delivery event has occurred. Premium kids are not covered until the premium is paid or 30 days after the application whichever is later. See Income Maintenance Manual section 0920.020.15 Payment of Premium.
If an ineligible alien applies for healthcare coverage and states they have had no emergency care, do not process the application as an EMCIA request. Complete a MO HealthNet application for the appropriate category, rejecting the application for citizenship/alien status.
EMCIA Procedures based on Program
NOTE: Occasionally, there is an applicant who has already been determined PTD by MRT (and a medical review is not due). In these instances, the ES will need to gather the medical information pertinent to the emergency medical event. Send the information to MRT with an EMCIA cover sheet (IM-365) and a copy of the previous IM-61 that shows MRT approval. MRT will determine if the medical situation meets the emergency medical condition criteria and will notify state office. State office personnel will enter the dates of coverage and notify the ES of the dates of coverage or that the medical event was denied for emergency medical coverage. The eligibility specialist will then send the appropriate IM-32 or IM-33.
NOTE: Before sending the IM-365 to FSD.MEDES@dss.mo.gov staff must ensure that all evidence has been verified in the application case prior to denying the application.
When an application for an ineligible alien is rejected an Action Notice is sent to notify the applicant of ineligibility due to citizenship. The ES must mail a manual notice (IM-32 or IM-33) to the applicant after the medical determination is made to notify them of the EMCIA determination.
Eligibility for EMCIA entered into FAMIS can be viewed on the Medicaid Category History (FM4L/MEDHIST) screen. Entry of the dates of the emergency medical care is made directly to the Medicaid Category History (MEDHIST/FM4L) screen and is identified by an E in the Override Code (OC) field.
Coverage dates for programs in MEDES can only be viewed on the MO HealthNet Division Title XIX Cross Reference Eligibility (MXIX) screen in LEGACY system.
All rights to an administrative hearing are applicable to individuals requesting EMCIA. Ineligible aliens may request a hearing based on the MO HealthNet rejection, an EMCIA approval not covering total number of days requested, or a denial due to the absence of an emergency condition.