Emergency Medicaid coverage is limited to treatment required after the sudden onset of a medical emergency. The acute symptoms of the condition must be sufficiently severe that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Emergency Medicaid does NOT pay for treatment of chronic conditions, even if the condition has the potential to be life threatening. For example, a person with a heart condition that may lead to a heart attack unless it is treated cannot get Emergency Medicaid UNTIL there is a heart attack or sudden onset of a medical emergency.
This type of Medicaid can never be pre-approved. Instead the medical bill for the treatment of the emergency is submitted for review by a Medical Review team at the Connecticut Department of Social Services.
Emergency Medicaid covers labor and delivery for pregnant women who do not have health insurance and who meet Medicaid income and asset limits. It does not cover prenatal care.* However, if the pregnant woman has complications to her pregnancy or if the unborn baby is at risk, then Emergency Medicaid will cover the cost of care. Likewise, Emergency Medicaid will cover the cost of an abortion if the mother’s life is in danger, but not if the abortion is an elected procedure.
(* NOTE: Prenatal care for pregnant women who are not citizens or who do not have permanent residency can get prenatal care at community health centers.)
IMMIGRANTS AND NONCITIZENS
Immigration status is NOT a factor for Emergency Medicaid eligibility. Any person, regardless of legal immigrant status can be eligible for Emergency Medicaid if he/she meets income and asset limits.
NOTE: Hospitals cannot deny anyone emergency medical treatment, regardless of financial status or immigrant/citizenship status. So patients with medical emergencies would be able to get care, and financial payment sources would have to be determined later. The State of Connecticut reimburses hospitals for “uncompensated care.” In addition, most hospitals have discretionary funding that may be able to help when people unable to afford medical care cannot access Medicaid or HUSKY because of citizenship issues.
FOR MORE INFORMATION ABOUT EMERGENCY MEDICAID:
Connecticut Department of Social Services
SOURCE: Connecticut Department of Social Services
PREPARED BY: 211/tb
CONTENT LAST REVIEWED: May2017