Emergency MO HealthNet Care for Ineligible Aliens

1700.020.00 Ineligible Alien Status

IM-111 July 17, 2020, IM-66 November 17, 2013IM-49 May 13, 2013

When an ineligible alien makes an application for EMCIA, enter the application request for the appropriate federally funded MO HealthNet program. The application request must be entered after the emergency medical or labor/delivery event has occurred and within prior quarter time frames. Determine eligibility based on the MO HealthNet program’s requirements, excluding citizenship/alien status. MO HealthNet based on Permanent and Total Disability must have disability established through the normal Medical Review Team (MRT) process.

The eligibility factor of emergency medical condition will be determined by the MRT. The MRT will evaluate the medical records and determine if the criteria for an emergency medical condition has been met on each day that coverage is requested.

If an applicant is ineligible for a reason other than citizenship/alien status (such as income, financial resources, intent to remain), reject the application on the appropriate eligibility factor. Do not send medical records or signed releases for medical records to the Medical Review team for determination of an emergency medical condition when an applicant is ineligible for a reason other than citizenship.

NOTE: MO HealthNet for Kids premium cases will not be eligible for EMCIA because the request for Emergency MO HealthNet Care for Ineligible Aliens must be made after the emergency medical or labor/delivery event has occurred. Coverage on MHK CHIP premium case does not begin until the premium is paid or 30 days after the application whichever is later. See Income Maintenance Manual section 1840.025.00 Payment of Premium.

If an ineligible alien applies for healthcare coverage and states they have had no emergency care, do not process the application as an EMCIA request. Complete a MO HealthNet application for the appropriate category, rejecting the application for citizenship/alien status.

EMCIA Procedures based on Program

  • MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED BASED ON PERMANENT AND TOTAL DISABILITY (PTD)
    • Send the completed MHABD application, with the subject line “EMCIA” to MRT.ProcessingCenter@dss.mo.gov.
    • If MRT determines the ineligible alien meets PTD, and has an emergency medical condition, coverage will be entered as an override, by designated MRT staff.
    • State office will notify the local office via e-mail of the decision.
    • Field staff will send an Approval Notice (IM-32) or Notice of Case Action for Adult MO HealthNet and Cash Assistance (IM-33) that corresponds to the action taken.
    • A MO HealthNet card is NOT sent to the participant. The approval letter is the verification of coverage.
    • If the program is Ticket to Work Health Assurance (TWHA), staff will be asked to provide budgets and amount of premium for each month of EMCIA coverage.
    • If eligibility is based on spend down, (SD) staff will need to provide budgets and bills showing when SD was met for each month of EMCIA coverage.
    • NOTE: Occasionally an individual who was previously determined PTD by MRT and authorized for EMCIA coverage for an emergency event reapplies.  A new MHABD application is required, and normally the older MRT determination was date specific and disability will also need to be established again.   See 1060.005.25 for instructions
  • ALL MAGI PROGRAMS (Family MO HealthNet programs)
    • After application is processed, required verification is requested, including either medical records or a signed release form to obtain medical records.
      • If required verification is not received, reject application for “Requested verification not provided” and mail appropriate manual notification to applicant.
      • If required verification is received, reject application for citizen/Alien status and complete the IM-365 send all documentation to:
        • CoDFS@dss.mo.gov who will complete the EMCIA process (including MRT decision, if applicable)
    • The processing center completes the process by:
      • Entering the approved coverage and sending the approval notice; or
      • Sending a rejection notice.

For MAGI cases, MRT determines if the medical event meets the emergency medical condition criteria.  MRT does not need to determine PTD.

If approved, the approval letter is the verification of coverage.  A MO HealthNet card is not sent to the participant.

Coverage dates for programs in MEDES can only be viewed on the MO HealthNet Division Title XIX Cross Reference Eligibility (MXIX) screen in LEGACY system.

All rights to an administrative hearing are applicable to participants requesting EMCIA. Ineligible aliens may request a hearing based on the MO HealthNet rejection, an EMCIA approval not covering total number of days requested, or a denial due to the absence of an emergency condition.