Purpose: The Alien Emergency Medical (AEM) program is for non-citizens who:
Have a qualifying emergent medical condition;
Would be eligible for Medicaid if he/she were a citizen; and
Are ineligible for a full-scope Medicaid program due to immigrant status.
(c) Meet categorical eligibility criteria for one of the following programs, except for the social security number, citizenship, or alien status requirements:
2. AMLTC medically needy (MN) coverage is available for children, adults age sixty- five or over, or persons who meet SSI disability criteria. See WAC 388-519-0100 for MN eligibility and 388-519-0110 for spending down excess income under the MN programs.
3. The department does not consider a person's date of arrival in the United States when determining eligibility for AMLTC.
4. The department does not consider a sponsor's income and resources when determining eligibility for AMLTC, unless the sponsor makes the income or resources available.
5. A person is not eligible for AMLTC if that person entered the state specifically to obtain medical care.
6. A person who the department determines is eligible for AMLTC may be eligible for retro active coverage as described in WAC 388-416-0015.
7. Once the department determines financial and categorical eligibility for AMLTC, the department then determines whether a person meets the requirements described in WAC 388-438-0115, 388-438-0120, or 388-438-0125.
Ask yourself if the alien would be eligible for Medicaid if the alien were a citizen. If the answer is YES, the person is "related to" a Medicaid program. If the person also has a qualifying emergency medical condition, determine eligibility for the AEM program.
The medical care or services for the qualifying emergency medical condition may be provided in a physician’s office or may be hospital or nursing home based.
Hospital-based services include medical care or services provided to a patient in an emergency room, a hospital urgent care center, in a hospital day surgery, or an inpatient setting.
In addition to meeting the categorical criteria for a medical program described in Clarifying Information 1 a. and 1 b. above, coverage for nursing home services requires prior authorization from the HRSA Medical consultants.
Clients who are eligible for General Assistance cash will receive GA with state-pay Medical Care Services (MCS) medical. Clients who are aged, blind, or disabled and have an emergency medical condition can choose to not receive cash and receive only S07 CN medical coverage for the emergent condition. Dual program eligibility is not supported for these programs.
CENTRALIZED PROCESSING FOR CSD
Centralized Medical Unit (CMU) staff determine eligibility for non-HCS AEM cases.
Medical only applications received may be routed via DMS to CSO 132 @AEM for processing.
Applications received in the CSO that include requests for other programs are processed by the local office for other programs and by the CMU for AEM.
Set a same date tickler to CSO 132 @AEM for application processing
CMU Contact Information:
Address:
DSHS - CMU
PO Box 34350
Seattle, WA 98124-9511
Phone: (206) 341-7433, or Toll Free (800) 337-1835
