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Emergency Medicaid

October 13, 2021

The Basics of Emergency Medicaid

Medicaid is a government program that helps people with lower income levels pay for medical care. This health insurance covers basic care and emergencies, but there are some situations that Medicaid will not cover, including elective cosmetic surgery, embryo implantation, and acupuncture.

What is Medicaid?

Healthcare is something that everyone should have access to, regardless of their family’s income. Medicaid seeks to solve that coverage gap. Through the national health insurance program, Medicaid, low-income children, adults, senior citizens, and disabled individuals are able to access medical care that they may not otherwise be able to afford.

 

Medicaid provides 1 in 5 Americans with medical care, oftentimes being costly procedures and life-saving treatments. Covering a broad array of health services with minimal out-of-pocket costs can keep people from neglecting their medical care simply because they cannot afford it. In addition to Medicaid, the United States also has Emergency Medicaid that can help certain individuals with emergency medical care.

 

In order to qualify, you must meet certain medical and income requirements. Because this is a program for those with lower income levels and fewer assets, patients don’t have to pay deductibles or premiums. They also rarely pay copays or for prescriptions. Medicaid helps patients save a lot of money on the out-of-pocket costs that people often face when going to the doctor.

 

While there are federal laws about what is mandatory nationwide, each state establishes its own guidelines and programs for its residents. Federal mandates state that each state provides:

● Physician services

● Inpatient and outpatient hospital services

● Home healthcare services

● X-ray and laboratory services

 

Additionally, some states also provide:

● Prescription drugs

● Occupational therapy

● Physical therapy

● Case management

What is Emergency Medicaid?

Emergency Medicaid is a program that is offered across the country that provides emergency medical services to individuals who are ineligible for regular Medicaid. Ongoing conditions are not covered under this program, but most medical emergencies are covered.

 

One of the best things about the Emergency Medicaid system here in the United States is that the coverage could be available for anyone living here, regardless of immigration status. This means that individuals living in the states can still get medical care, even if they are in the process of becoming legal citizens. Many of the people who are eligible for Emergency Medicaid include:

● Undocumented people

● Non-immigrant visa holders (students and tourists)

● Deferred Action for Childhood Arrivals (DACA) recipients

● Individuals that have been granted Temporary Protected Status

● Adult Green Card holders who have not been in the U.S. legally for 5 or more years (does not apply to kids or pregnant people, as they qualify for full Medicaid

 

Emergency Medicaid is a lifesaving program because many individuals can’t afford to pay for private health insurance or the full price of most medical procedures. Although routine appointments and procedures aren’t covered by Emergency Medicaid, there are a number of emergency situations that are eligible. It covers emergency care that you received over the past three months.

How Long Does Emergency Medicaid Coverage Last?

Emergency Medicaid is an important resource for uninsured individuals who are unable to use Medicaid for any reason. Patients could be authorized for a period of up to 15 months. This can include 3 months prior to the application and up to 12 months after.

What is Considered an Emergency Medical Condition?

An emergency medical condition is defined as a medical condition that shows acute symptoms of sufficient severity, including severe pain, that without medical attention, may result in any of the following:

● The patient's health is placed in serious jeopardy;

● Serious impairment to bodily functions; or

● Serious dysfunction of any body organ or part.

 

The initial emergency medical care, including labor and delivery, is covered, but any follow-up treatments or ongoing care are left up to the patient and/or their insurance to handle. It’s also important to keep in mind that not all medically necessary procedures are considered a medical emergency.

Exceptions to Emergency Medicaid

Emergency Medicaid is limited to medical treatment that is necessary following a medical emergency. This means that treatments of chronic conditions are NOT covered, even if the results of the condition could potentially threaten the patients’ life.

 

Things not covered by Emergency Medicaid include:

● Treatments related to organ transplants

● Rehabilitation services, including physical therapy and speech therapy

● Alternative level of hospital care

● Home care or nursing facility services

 

Emergency Medicaid does not cover these conditions because they do not meet the criteria to be considered an emergency medical condition.