POL M1205:        DETERMINING ELIGIBILITY FOR EMERGENCY SERVICES

1.    Applicants May Be Eligible For Emergency Services

Applicants may be eligible for temporary coverage for an emergency service when they meet all the eligibility requirements for a Medicaid program excluding U.S citizenship, identity and social security number requirements. Refer to Section M604 for information on determining Citizenship/Immigration status. 

Applicants who do not meet the Citizenship/Immigration requirements are not eligible for Emergency Services under the Nursing Home, Home & Community Based Services Waivers, Hospice, Pregnant By Choice, Employed Individuals With Disabilities, Breast and Cervical Cancer, Tuberculosis, Kid Care CHIP or Medicare Savings Programs.

2.    Sponsor's Income And Resources May Not Be Available

The income and/or resources of a sponsor is not available unless the sponsor signed an Affidavit of Support with the U.S Citizenship and Immigration Services.  

When an affidavit has been signed, deem the income and resources of the sponsor and the sponsor's spouse, until one of the following occurs:

• Immigrant becomes a citizen.

• Sponsor dies.

3.    Benefits Begin First Month Eligible

Eligibility for Emergency Services is determined one month at a time. 

• Clients receive benefits beginning in the first month eligible.

• Clients may request retroactive benefits for each month they incurred medical services for an emergency, up to three months prior to their application.

• Clients who are pregnant and apply within two months of their due date may receive benefits for the two months prior to due date, month of due date and month of delivery. Clients who are pregnant and their due date is not within the next two months will be reviewed for the month of application only. Individuals must reapply when an emergency medical service is incurred after the end date in WES.

4.    Benefits Are Limited To Emergency Services

Medicaid Fiscal Agent reviews all claims for service and determines if the service meets the criteria for an emergency service.

5.    Pregnant Women Services Limited To Emergency Services

Labor and delivery are considered emergency services.

Routine prenatal and postpartum care is not included in Emergency Services benefits.

6.    Newborns May Receive Automatic Eligibility

An application is not required for newborns born to a Medicaid eligible mother.

Newborns are automatically eligible, beginning with the month of birth and continue through the end of the month of the child's first birthday, when both of the following conditions are met:

• Newborn of mothers eligible for Emergency Services.

• Child continues to live in Wyoming.