Emergency Medical Assistance (EMA) is not a Medicaid COA; however, the applicant must meet the requirements of a COA to be eligible for EMA.  Eligibility exists only for the days that emergency medical services are provided.

The need for emergency medical service must be verified by a doctor using Form 526.  Approval for EMA will be for a service that was provided prior to the date of application. EMA applications are not to be approved prior to an emergency, including labor and delivery. No future eligibility dates are to be used.   Medical coverage for the birth of a child is the most common type of service.  Services can include labor and delivery, from active labor until delivery is complete and mother and baby are stabilized, but not routine pre-natal or postpartum care.

Tatayana Tolstoya is a lawful alien.  However, she does not have a Department of Homeland Security (DHS) status that permits eligibility for Medicaid.  She gives birth to a baby boy on November 5 and applies for Medicaid on December 1.  She lives with her husband, Ivan, who earns a salary of $2000 per month.  This income is over the income limit for LIM, but is under the RSM income limit for a pregnant woman in a BG of three.

Mrs. Tolstoya meets all eligibility requirements for RSM-Pg except DHS status.  As a result, Mrs. Tolstoya is eligible under EMA only for the day(s) that emergency medical services were provided for the birth of her son.  These days have to be verified by a doctor.  Mrs. Tolstoya is not eligible for RSM through the month following the sixtieth day after the birth of her child.  Her child is not eligible for Newborn Medicaid. You should determine whether the baby is eligible for LIM or RSM.

EMA is a unique way of providing Medicaid coverage.  If an A/R is not a U.S. citizen and his/her DHS status is indeterminable, or the A/R is not a lawful resident, contact your supervisor. An individual who is not a U.S. citizen is considered an alien.  Aliens who have lawfully entered the U.S. are assigned a status by DHS.  This status determines eligibility for the citizenship/alienage requirement in Medicaid.  Aliens do not meet the citizenship/alienage requirement if they did not enter the U.S. lawfully, cannot verify their INS status, or are violating the terms of their entry.  Mouse-click to see citizenship/alienage in the RSM Summary of the Points of Eligibility.