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
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.
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
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.