Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: INTRODUCING EMERGENCY MO HEALTHNET CARE FOR INELIGIBLE ALIENS (EMCIA) PROVIDER REQUEST FORM (IM-365P)
FORM REVISION #
A new form, Emergency MO HealthNet Care for Ineligible Aliens (EMCIA) Provider Request (IM-365P), was created for providers who are assisting ineligible aliens applying for MO HealthNet and requesting an EMCIA determination.
EMCIA provides health coverage for emergency medical care of aliens who meet all eligibility requirements for MO HealthNet except citizenship/alien status. The IM-365P allows providers to identify applicants who have had emergency medical care and could qualify for EMCIA coverage.
Providers should submit the IM-365P and any required medical records through the provider portal.
The IM-365P is available in the public and internal forms manuals.
- Review this memorandum with appropriate staff.