Emergency MO HealthNet Care for Ineligible Aliens

1700.010.10 Emergency Medical Condition

IM-49 May 13, 2013

An emergency medical condition must exist or have existed in the month of application, or in one of the prior quarter months. The individual does not have to enter the hospital or medical facility via an emergency room to qualify. An emergency medical condition is defined as follows:

  • The medical condition must be one that manifests 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:
    • Placing the patient’s health in serious jeopardy;
    • Serious impairments to bodily functions; or
    • Serious dysfunction of any bodily organ or part.
  • All labor and delivery is considered emergency labor and delivery.

Labor and delivery excludes pre- and post-partum care. Refer individuals who need prenatal care to Temporary MO HealthNet during Pregnancy (TEMP) qualified provider to apply for TEMP.

  • Standard labor and delivery covered by EMCIA is defined as:
    • one day prior to delivery and 2 days after for normal delivery, or
    • one day prior to delivery and 4 days after for Caesarean-section.
  • Non-standard labor and delivery is any dates of service requested other than coverage defined above as standard labor and delivery.

Medical documentation is required for all emergency conditions except for standard labor and delivery. Documentation should include the EMCIA cover sheet (IM-365) medical records, signed releases for medical records, and any other information pertaining to the medical condition that is available. The Medical Review Team (MRT) will make the determination if the medical event qualifies as an emergency medical condition, except for standard labor and delivery. See procedures based on program in Income Maintenance Manual section 1700.020.00 Ineligible Alien Status.