U.S. born citizens, naturalized citizens, legal permanent residents (LPR), and numerous other “qualified” immigrant statuses are all eligible for full Medical Assistance. See Immigrant Health Care Manual For Advocates and additional materials on our website. Immigrants who are not eligible for full Medical Assistance are eligible for Emergency Medical Assistance.
Emergency Medical Assistance is available to immigrants who meet the criteria for medical assistance but who would be denied solely because of immigration status. These include:
- Immigrants who have been in a “qualified” status for less than 5 yrs;
- Immigrants who are undocumented;
- Immigrants who are here on expired visas; and
- Immigrants who are here on a temporary basis, such as people on student or visitors visas.
EMA is a temporary enrollment in the MA program to treat a specific problem. After that treatment is complete, the enrollment ends.
What is an Emergency Medical Condition?
At the outset, understand that the term “Emergency Medical Assistance” is a misnomer. EMA does not require an “Emergency” in the “Emergency Room” sense of the word. It does require that the immigrant have an “ Emergency Medical Condition ” (EMC). An EMC is simply a serious medical condition meeting a specific definition which may or may not require the immigrant to go to an Emergency Room.
A medical condition with acute symptoms of such severity, including severe pain, that without immediate medical attention,
- The person’s health is in serious jeopardy; or
- The person faces serious impairment to bodily function; or
- The person faces serious dysfunction of any body organ or part.
NOTE: This legal definition covers many conditions that differ from an acute medical emergency requiring immediate medical attention to prevent death.
An emergency medical condition includes labor and delivery services. An emergency medical condition does not include care and services related to organ transplant procedures.
What is the physician’s role?
To qualify for Emergency Medical Assistance, an applicant must have a letter from a physician which:
- Identifies the Emergency Medical Condition (EMC);
- Specifies the need for immediate medical treatment resulting from the Emergency Medical Condition;
- Provides an end date for the EMC using real calendar dates. When predicting the end date is difficult, physicians must use their most educated estimation. As a general rule, asking for > 6 month authorization decreases the chance of approval. It is better to ask for a shorter period of time and a re-authorization if needed.
- Specifies the kinds of treatments which will be needed; for example doctor’s visits, hospitalization, pharmaceuticals, or surgery
- Your letter will be most effective if you use the exact language of the above stated definition of Emergency Medical Condition!
- Identify/diagnose the EMC
- State the patient meets one (or more) of the EMC definitions using the exact language of the definitions
- State the specific treatments, including duration/frequency of treatments, necessary diagnostic testing, and names of medications that are or may be required. If possible, explain the consequences if no treatment is administered (paralysis, death, future expensive emergency treatment).
- State that the need for treatment is “immediate”
Click here for a template for a letter to request emergency medical assistance.
Click here for a sample Emergency Medical Condition letter.
- Condition does not need to be of such emergency status that immediate same day treatment is required! It merely needs to be so urgent that it meets the above stated definition of Emergency Medical Condition. Examples of some Emergency Medical Conditions that have been approved in PA:
- Breast cancer treatment (chemotherapy; radiation- 9 months);
- Surgery to repair damaged tendons in the hand;
- Biopsy of a testicular mass;
- Cone biopsy to remove moderate dysplasia
- Anapplicant for EMA is NOT required to:
- Sign citizenship/alienage declaration form;
- Verify immigrant status;
- Give a Social Security #.