COVID-19 ALERT - See here. COVID-19 lab testing, evaluation, and treatment are emergency services and will be reimbursed by NYS Medicaid for individuals who are undocumented immigrants eligible only for emergency Medicaid.
August 2019 ALERT - On Monday August 12, 2019, the Department of Homeland Security finalized a rule that dramatically expands the “public charge” immigration policy. The changes will apply only to applications that are postmarked or submitted electronically on or after October 15, 2019. They change the definition for deciding whether an immigrant who receives Medicaid or other government benefits is considered a "public charge" -- which can result in denial of Lawful Permanent Resident status (green card), denial of an extension of a non-immigrant visa, or deny admission to the U.S. Read more about this here. Under the finalrule, receipt of Medicaid for treatment of an emergency medical condition, as discussed in this article, will NOT be considered in whether an individual is a "public charge." See also New England Journal of Medicine article, A New Threat to Immigrants’ Health — The Public-Charge Rule, Sept. 8, 2018 . Read more about the final rule here, with links to national advocacy resources.
Federal law requires state Medicaid programs to provide Medicaid coverage for "care and services are necessary for the treatment of an emergency medical condition" to immigrants who do not meet the immigration requirements for full Medicaid. This would be immigrants who are not PRUCOL. They must “otherwise meet the eligibility requirements for medical assistance under the State plan." 42 U.S.C. § 1396b(v)(2)(A)-(C) . To qualify for Emergency Medicaid, clients need to be residents of New York State, financially eligible for Medicaid (under applicable rules for the individual's category (MAGI/ NON-MAGI), 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. See NHELP, Medicaid Coverage of Emergency Medical Conditions.
Applications for Emergency Medicaid are filed the same way as for regular Medicaid. Those qualifying for MAGI apply on https://nystateofhealth.ny.gov/ Those who are age 65+ or younger and have Medicare apply at their local district social services department. See article for where to apply in NYC
NYS directives are summarized below.
Which Services are Covered as an Emergency?
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. There has been much case law regarding what treatment is an emergency. Organ transplants are specifically excluded in the federal statute. Nursing home care has been excluded. Greenery Rehabilitation Group, Inc. v. Hammon, 150 F.3d 226 (2d Cir. 1998). There are numerous other cases. See 2010 update . See NHELP, Medicaid Coverage of Emergency Medical Conditions.
This article was authored by the Health Law Unit of the Legal Aid Society.