Citizenship and Alien Status Requirements for the Medicaid Program
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- Date
- NOTE: THE ABOVE WMS ALIEN CITIZENSHIP INDICATOR CODES (ACI CODES) ARE NOT TO BE CONFUSED WITH USCIS VISA CATEGORIES.
- Manual Notice Form 36622A is rescinded.
Date: October 26, 2004
33 Trans. No. 04 OMM/ADM-7
(including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:
-placing the person’s health in serious jeopardy; -serious impairment to bodily functions; or
-serious dysfunction of any bodily organ or part. Treatment of emergency medical conditions does not include care and services related to an organ transplant procedure.
Federal regulations at 42 CFR 440.255 provide that federal reimbursement is available after the sudden onset of the medical condition. Certain types of care provided to chronically ill persons are beyond the intent of federal law and are not considered emergency services. Such care includes alternate level of care (including private duty nursing) and personal care.
Temporary nonimmigrants and undocumented immigrants applying for coverage for the treatment of emergency medical conditions must submit the LDSS-3955 (Upstate) or MAP 2151 (NYC): “Certification of Treatment of Emergency Medical Condition,” completed and signed by a physician. The DSS-3955 has been revised is attached to this directive as Attachment E-1. Social Service districts must begin using the revised LDSS-3955 immediately. Social services districts must discard any existing supplies of the previous version of the LDSS-3955.
Because the care that can be covered by Medicaid under the definition of emergency medical condition is limited, authorizations for emergency care must cover a specific period of time in the past. The social services district must notify the provider of the acceptance/denial of the application, the period of coverage and the individual’s Client Identification Number (CIN) when appropriate.
A new DSS-3955 or MAP 2151 must be obtained from a physician at least once every 90 days, in order to continue the Medicaid authorization. V. SYSTEMS IMPLICATIONS
Upstate Systems Implications Over the past few years, various systems changes have been implemented to support the Department’s policy pursuant to the Aliessa decision. The purpose of this section is to reiterate existing system support for these immigrants.
WMS utilizes a series of Alien/Citizenship Indicator Codes (ACI) to identify citizens, qualified and PRUCOL immigrants, and those immigrants eligible for the treatment of an emergency medical condition.
Date: October 26, 2004
34 Trans. No. 04 OMM/ADM-7
supported by WMS: CITIZENSHIP/ALIEN INDICATOR CODES A Person Granted Asylum B Battered Alien C Citizen D Trafficking Victims (Upstate) E Alien Only Eligible for Emergency F Person Granted Conditional Entry G Person Paroled into the U.S. for at Least 1 Year H Cuban and Haitian Entrant J Person whose Deportation is being withheld K Lawful Permanent Resident W/O 40 Quarters or 40 Quarters Not Determined M Qualified immigrant on Active Duty in Armed Forces (inc. Spouse & Dependent Child) N PRUCOL Alien Diagnosed with AIDS or Residing in RHCF on 8/4/97 O PRUCOL Eligible for MA/FHP/CHPA/SN/FAP R Person Admitted as Refugee/Amerasian (includes Victims of Trafficking-NYC)
Child)
NOTE: THE ABOVE WMS ALIEN CITIZENSHIP INDICATOR CODES (ACI CODES) ARE NOT TO BE CONFUSED WITH USCIS VISA CATEGORIES.
In addition to the ACI, the proper Recipient Coverage Code and/or State/Federal Charge Code should be entered, as described below, to assure that the proper Federal/State/Local shares are derived.
Specifically; for individuals in the five year federal ban, the following system support exists: 1. For fully eligible, fee for service (non-Managed Care) individuals, Recipient Coverage Code 11 (Legal Alien – Full Coverage) is now generated for Case Types 11, 12, 16, 17, and 20. This Coverage Code produces an Aid Category Value of 76 (Legal Alien – FNP). This Aid Category assures that non-emergency Medicaid claims are reimbursed at 50% State/50% Local share. - Entry, or generation, (if Blank) of the Coverage Code 11 is allowed for ACI of B, F, G, K, S or T when the Date of Entry is greater than or equal to 9/96 and the MA coverage “from” date is less than five years from the Date of Entry (DOE). - When the ACI is N or O, Coverage Code 11 is entered or system generated. ACI codes N or O are always FNP regardless of the Date of Entry.
Date: October 26, 2004
35 Trans. No. 04 OMM/ADM-7
the appropriate Managed Care, FHP, or spenddown Coverage Code should be entered. Entry of a Coverage Code 11 is valid for entry into the PCP subsystem. Following storage of the PCP enrollment, the proper PCP Coverage Code will be generated based upon the recipient’s Categorical Code. It is important to data enter the State/Federal Charge Code of 60 or 67 so that when the Coverage Code is changed, proper State and Local claiming is achieved (Details in GIS 02 MA/002 and 01 MA/030).
Specifically: a.
State/Federal Charge Code 60 (TANF Ineligible Alien) should be entered on any case type .
- State/Federal Charge Code 60 is required for individuals with a Citizenship Indicator of B, F, or K and a Date of Entry greater than or equal to 9/96 and an MA From Date less than five years from the Date of Entry. b.
the five year ban for Medicaid/PRUCOL) should be entered for MA Only (Case Type 20), Family Health Plus (Case Type 24) and Cash Assistance (Case Types 11, 12, 16, 17) cases. - State/Federal Charge Code 67 is also required when the ACI is G, S, or T and the Date of Entry is greater that or equal to 9/96 and the MA From Date is less than five years from the Date of Entry. - State/Federal Charge Code 67 is also required for an ACI of O. Since O does not require a Date of Entry, 67 is required regardless of the Date of Entry, including a BLANK.
3.
Anticipated Future Action (AFA) Code 522 (Expiration of MA 5 Year ban) will appear on WMS Report, WINR 4137- Undercare-Notice of Anticipated Future Action, when the federal 5 year ban is due to expire
. The 522 AFA Code can be data entered or is system generated 4 years, 11 months after the Date of Entry. The worker should then remove the State/Federal Charge Code from WMS.
4. Emergency Medical Assistance is provided to illegal or undocumented immigrants and temporary nonimmigrants who are in need of care due to an emergency medical condition and are otherwise eligible. In order to properly pay for these services, the ACI for these individuals must be “E” (Aliens Only Eligible for Emergency MA). In addition, the Recipient Medicaid Coverage Code on Screen 5 should be “07” (Emergency Services Only). The Medicaid Coverage From and To Dates should reflect the actual duration of the emergency condition and must be date specific. When a claim is received from an enrolled provider indicating it is for the treatment of an Emergency, the claim will be paid with federal participation (50% Federal/25% State/25% local).
NYC Systems Implications New York City WMS instructions have been issued separately.
Date: October 26, 2004
36 Trans. No. 04 OMM/ADM-7
As of November 2004, with the implementation of CNS Acceptance Notices (upstate) for the treatment of an emergency medical condition, Manual Notice Form 3622 will be revised deleting all references to emergency medical care.
Social services districts must discard any existing supplies of the previous version of the manual notice 3622A.
CNS Notices of Acceptance (Upstate) for the treatment of an emergency medical condition, including spenddown cases have been developed:
Reason Code Paragraph # Description •
Y0051 “Accept
Nonimmigrant/Undocumented Immigrant Emergency Excess Income” •
Y0052 “Accept
Nonimmigrant/Undocumented Immigrant Emergency Coverage Only” •
Y0057 “Accept
Nonimmigrant/Undocumented Immigrant Emergency Excess Resources” •
Y0058 “Accept
Nonimmigrant/Undocumented Immigrant Emergency Excess Income and Resources” •
E0007 “Explanation of the Excess Income Program for Nonimmigrant/Undocumented Immigrant Emergency Only” •
Nonimmigrant/Undocumented Immigrant Emergency Only”
In addition, revisions were made to existing CNS notices (denials and discontinues) to reflect the Aliessa
court decision. The language has been changed to include additional categories of immigrants not included in current notices.
New York City should use the approved language from the body of the Upstate CNS notices for their manual notices.
We anticipate the CNS notices migrating in November 2004, will cover most contingencies. However, in the unlikely event the LDSS must use a manual notice, local districts are reminded to use the following language to deny/discontinue undocumented immigrants and temporary nonimmigrants (i.e. formerly called “nonqualified/non-PRUCOL aliens”):
“This is because you are not a citizen, qualified alien or permanently residing in the United States under color of law (PRUCOL).
To be eligible for New York State Medicaid Programs, individuals must be a U.S. citizen, national, Native American or have satisfactory immigration status.
Date: October 26, 2004
37 Trans. No. 04 OMM/ADM-7
one of the following categories: Qualified “aliens” include the following immigrants: •
•
persons admitted as refugees; •
persons granted asylum; •
persons granted status as Cuban and Haitian entrants; •
persons admitted as Amerasian immigrants; •
persons whose deportation has been withheld; •
persons paroled into the United States for at least one year; •
persons granted conditional entry; •
persons determined to be battered or subject to extreme cruelty in the United States by a family member; •
Victims of trafficking; or •
Veterans or persons on active duty in the Armed Forces and their immediate family members. PRUCOL “aliens” include the following immigrants: •
•
persons residing in the United States pursuant to an Order of Supervision; •
persons residing in the United States pursuant to an indefinite stay of deportation; •
indefinite voluntary departure; •
persons on whose behalf an immediate relative petition has been approved and their families covered by the petition; •
that INS has accepted as “properly filed” or has granted; •
persons granted stays of deportation; •
persons granted voluntary departure; •
persons granted deferred action status; •
persons who entered and continuously resided in the United States before January 1, 1972; •
•
other persons living in the United States with the knowledge and permission or acquiescence of the USCIS and whose departure the USCIS does not contemplate enforcing. Examples include but are not limited to the following: - permanent non-immigrants, pursuant to Public Law 99-239 (includes Citizens of the Federated States of Micronesia and Marshall Islands); - applicants for adjustment of status, asylum, suspension of deportation or cancellation of removal, or deferred action or persons granted extended voluntary departure, or Deferred Enforced Departure (DED) for a specified time due to conditions in their home country; - persons granted Family Unity; or - persons granted Temporary Protected Status.
Date: October 26, 2004
38 Trans. No. 04 OMM/ADM-7
for a temporary or specified period of time as legal nonimmigrants (i.e. tourists, short term visa holders and foreign students). These immigrants are not eligible for Medical Assistance under Medicaid because of the temporary nature of their admission status. However, individuals who are not citizens, nationals, Native Americans or in satisfactory immigration status may receive Medical Assistance coverage ONLY for the treatment of emergency medical conditions, or for medical services provided to pregnant women, if they are otherwise eligible.
This decision is based on Regulations 18 NYCRR 360-3.2(j), 360-3.3, 360-4.8, Section 122(1)(e) of the Social Services Law and General Information System (GIS) 01-MA-026 and 01-MA-030.
only for coverage for the treatment of an emergency medical condition, if they meet all other eligibility requirements.
The provisions of this OMM/ADM are effective immediately.
______________________________________
Kathryn Kuhmerker, Deputy Commissioner
Office of Medicaid Management Document Outline
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