Eligibility Online Manual

M1205 Emergency Services

Purpose:  This section will assist in determining whether individuals are eligible for Emergency Services.

Current Policy Effective Date:  February 1, 2021

Date Last Reviewed:  March 25, 2022

Previous Policy:  April 1, 2021


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:

3.    Benefits Begin First Month Eligible

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

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:


Defining Group: 42 CFR 435.406

Defining Emergency Services: 42 CFR 435.139

 42 CFR 440.255

Clarifying Information:

Worker Responsibilities: