POLICY HISTORY FOR 3.2.3 EMERGENCY SERVICES

Release 05-02

3.2.3 EMERGENCY SERVICES

3.2.3.1 MA Deductible

3.2.3.2 Pregnancy

3.2.3.3 Alien Status Chart

An alien found ineligible under regular MA due to citizenship status can be eligible for emergency MA if they meet all other eligibility requirements.  (Aliens are not required to have a SSN for emergency services.)  If they would be eligible for any MA category including Healthy Start, they qualify.  However, they are ineligible if the only category of MA they would be eligible for is BadgerCare.

An emergency means a medical condition that shows acute symptoms of sufficient severity (including severe pain) such that the lack of immediate MA could result in one or more of the following:

1. Serious jeopardy to the patient's health.

2. Serious impairment to bodily functions.

3. Serious dysfunction of a bodily organ or part.

The medical provider will submit a claim to EDS and EDS will determine if the situation was an emergency that is covered by MA.  

If a non-qualifying alien provides you with a “Provider Certification of Emergency Form” at the time of application, determine his/her eligibility for emergency services.  You do not have to determine if an emergency exists.  Your responsibility is to see if the non-qualifying alien meets all other eligibility requirements and to certify if s/he is eligible.

Complete and return a HCF 10110 ( Formerly DES 3070 ).  The HCF 10110 may be returned by:

1. Mail: EDS

P.O. Box 7636

Madison, WI 53707

2. E-mail: ds_3070@dhfs.state.wi.us
    

3. Fax: (608) 221-8815

Use the AE medical status code.  Emergency coverage lasts from the time of the first treatment for the emergency until the condition is no longer an emergency.  The person will not receive a MA card because MA ends when the emergency ends.

EDS needs a beginning and end date to process eligibility.  In setting the end date, use the last day of the emergency.  If that is not known, use the last day of the month in which the emergency is expected to end.

3.2.3.1 MA Deductible

Aliens who apply for emergency services may become eligible by way of the MA deductible.  If, on the date they apply, they are eligible in all respects except income, apply the same deductible policies (4.9.1) to them as to any other client.

3.2.3.2 Pregnancy

All labor and delivery services are emergency services and are covered under emergency MA for eligible non-qualifying aliens.  An alien who gives birth and is eligible for emergency MA is eligible for a 60-day pregnancy extension.  The extension covers emergency MA only.  The emergency does not have to be related to the pregnancy.

A pregnant non-qualifying alien may apply for emergency services up to one calendar month before her due date.  Certify an eligible pregnant non-qualifying alien from the date of application, if it is no more than one calendar month prior to her due date, through the end of the month in which the 60th day occurs following her due date.  Adjust the certification period based on the actual pregnancy end date, once it is known.

If a pregnant non-qualifying alien applies prior to the calendar month before her due date and she has not received a service, deny her emergency services eligibility because she has not received a service.

If a woman applies for emergency services after her pregnancy has ended, certify her from the pregnancy end date through the end of the month in which the 60th day occurs.

3.2.3.3 Alien Status Chart

*"Veteran" includes certain veterans and active duty servicemen and women, their spouses, dependent children, or certain surviving spouse.

This page last updated in Release Number : 02-04

Release Date: 10/01/02

Effective Date:10/01/02