Emergency Medical Assistance (EMA) covers emergency services for legal noncitizens who are not eligible for regular Medical Assistance (MA) coverage with a federal match, undocumented persons, and nonimmigrants. EMA is administered by the Department of Human Services (DHS); the state receives the regular federal Medicaid match for the cost of EMA services. Eligibility and covered services for EMA are specified in Minnesota Statutes, section 256B.06, subdivision 4, paragraphs (f), (g), and (h), and Laws of Minnesota 2012, chapter 247, article 1, section 29.
Individuals must have an MA basis of eligibility (which means they belong to a group for which MA coverage is available) and meet all MA eligibility requirements such as income and asset limits, other than those related to immigration status.
The following groups of individuals are eligible for EMA:
- Legal noncitizens who do not qualify for regular MA with a federal match due to their immigration status (pregnant women and children who are legal noncitizens qualify for regular MA with a federal match regardless of their immigration status)
- Sponsored immigrants ineligible for MA because of the deeming of sponsor income and assets (pregnant women and children under age 21 are exempt from sponsor deeming)
- Undocumented persons and nonimmigrants, such as tourists and foreign students (uninsured pregnant women in these groups qualify for regular MA services through the period of pregnancy, including labor and delivery and 60-days postpartum)
Services Covered Under EMA
Minnesota law specifies that EMA covers “care and services necessary for the treatment of an emergency medical condition” as this term is defined in federal law. Federal law (42 U.S.C. 1396b (v)) defines an emergency medical condition as “…a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate attention could reasonably be expected to result in –
- (A) placing the patient’s health in serious jeopardy,
- (B) serious impairment to bodily functions, or
- (C) serious dysfunction of any bodily organ or part.” The Research Department of the Minnesota House of Representatives is a nonpartisan office providing legislative, legal, and information services to the entire House.
Limits on delivery settings and services
The 2011 Legislature limited the settings under which EMA services can be provided, and also specifically excluded certain services from being considered services for the treatment of emergency medical conditions. These changes, effective January 1, 2012, had the effect of eliminating EMA coverage for many chronic care and long-term care services.
Services available under EMA are limited to: (1) services delivered in an emergency room or by an ambulance service directly related to treatment of an emergency condition; (2) inpatient hospital services following admission from an emergency room or clinic; and (3) follow-up services directly related to the original service provided to treat the emergency condition that are covered by the global payment made to the provider.
Certain services are specifically excluded from coverage under EMA. These services include, but are not limited to: transplants and routine prenatal care (both of these services had been specifically excluded under prior law); continuing care; preventive health care and family planning services; rehabilitation services; physical, occupational, and speech therapy services; case management; and chemical dependency treatment.
Coverage of additional services
EMA may cover services provided in a nursing facility or home/community setting following discharge from an emergency department or inpatient hospital, if these services are part of a care plan certified by DHS and are medically necessary and required to prevent the individual’s condition from quickly becoming an emergency medical condition (typically within 48 hours); other criteria also must be met. Certain services, such as emergency dental services, personal care assistant and home care services, and outpatient prescription drugs, require authorization by DHS in addition to care plan certification, in order to be covered under EMA.
Temporary reinstatement of coverage
The 2012 Legislature temporarily reinstated, for the period May 1, 2012, through June 30, 2013, EMA coverage for: (1) dialysis services provided in a hospital or freestanding dialysis facility; and (2) surgery and chemotherapy, radiation, and related services necessary to treat cancer that is not in remission. Coverage for these services had been eliminated effective January 1, 2012.
Study of EMA
The 2012 Legislature also required the Commissioner of Human Services, in consultation with relevant stakeholders, to develop a plan to provide coordinated and cost-effective care to persons eligible for EMA. The plan must be submitted to the chairs and ranking minority members of the legislative committees with jurisdiction over health and human services policy and financing by January 15, 2013.
This and any related posts have been adopted from the Minnesota House of Representatives Research Department’s Information Brief, Emergency Medical Assistance, written by legislative analyst Randall Chun.