There has been a flurry of activity over the past few days surrounding the issue of emergency medical assistance (EMA) services no longer being available for individuals who are “undocumented.” Here are some of the latest updates:

The Department of Human Services (DHS) sent a notice last weekend advising parties that due to a substantial volume of recipient appeals related to the changes in EMA coverage that were to take effect on 1/1/12, DHS has been unable to identify all of the individuals for whom current EMA coverage should be continued because of a pending appeal. Therefore, DHS will continue to cover regular EMA services and pay those claims for services provided to all recipients on EMA from 1/1/12 through 1/8/12. DHS will be providing additional information about how to identify those clients whose coverage will be extended due to an ongoing appeal — including how to verify eligibility during the appeal period — on their health care provider webpage. If you have additional questions regarding specific claims, please contact the MHCP Provider Call Center at (651) 431-2700 or 1-800-366-5411.

Appeals Judge Inta Sellars, who is overseeing the EMA appeals process (although assigning cases out to individual judges), has confirmed the following:

• Some initial EMA appeals were summarily denied for lack of jurisdiction — as due to a legislative action.
• They are now scheduling a hearing for anyone who files an EMA appeal, due to the DHS notice to clients that offered the right to an appeal. Those who already received a summary denial must contact the appeals office to request a hearing, which will then be scheduled.
• All hearings are being scheduled out at least 30 days to allow time for the review of eligibility for the limited exception.
• For those not found eligible for an exception who filed an appeal, they will be able to challenge this in the hearing.
• The judges will hear any substantive issues related to the exception; however, where it is clear that an individual's conditions do not meet the exception, it is expected that the hearing will be fairly short.

Finally, staff from DHS coordinating the review of the exceptions have noted they are early in the process of reviewing the first batch of 50 (and know many more are coming in), so they do not yet have insight into how many are getting approved, or what types of conditions seem to tip the decision one way or the other. Note, as we have written earlier, the exception only applies for people in a nursing facility or receiving certain home care services (and also having a very dire pulmonary or respiratory condition).

The Association continues to work with legal aid, the Immigrant Law Center and the Safety Net Coalition in advocacy and strategy development on this issue.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

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