Criteria for Approval of Emergency Services

Criteria for Approval of Emergency Services A. Non-citizens who are not entitled to full Medicaid benefits may be eligible for emergency services only, if the following conditions exist: 1. All other eligibility requirements are met except satisfactory immigration status. 2. Care and services needed are not related to an organ transplant procedure or routine prenatal or postpartum care. 3. The non-citizen has, after sudden onset, a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: a) Placing the patient’s health in serious jeopardy, b) Serious impairment to bodily functions, c) Serious dysfunction of any bodily organ or part, or d) The patient requires services for labor and delivery. B. The services provided in this situation must relate to the injury, illness, or delivery causing the emergency. Services that are not directly related to the injury, illness, or delivery are not compensated by Medicaid. Once the medical condition is stabilized, even if it remains serious or results in death, it is no longer an emergency.