Over the past few weeks we have been giving you updates in this newsletter on the elimination of payment from the Emergency Medical Assistance (EMA) program for all of the non-emergency medical services that persons on this program may have been receiving, which includes nursing facility services.

After January 8, 2012, EMA will only pay for the care and treatment of emergency medical conditions, including labor and delivery, in an emergency room or inpatient hospital. EMA is a state and federally funded program that pays for emergency health care for certain non-citizens regardless of immigration status. Here is this week’s update:

Late last week a group of attorneys from several different organizations and law firms met to discuss the possibility of filing a lawsuit to delay or prevent the implementation of the Emergency Medical Assistance (EMA) cuts. As the legal preparations will take some time, and time is of the essence, this group sent a "demand letter" last Friday to the Commissioner of Human Services (DHS) indicating that lawsuits are planned; and requested that DHS further delay the implementation of the program beyond January 8 until there is an opportunity for the plaintiffs and attorneys to meet with DHS to discuss and attempt to resolve the legal disputes without resorting to legal action. The delay would help prevent serious harm to patients and providers that will occur if EMA coverage is not continued until the legal issues are resolved.

Earlier this week, Minnesota Public Radio ran a story on the EMA situation. Sasha Aslanian, the reporter, presented the issue and Rep. Jim Abeler, chair, House Health and Human Services Finance Committee, was quoted as saying he is developing a proposal for how some services beyond traditional emergency services could be restored using a coordinated care model. Under this model a fixed payment amount would be provided to a provider alliance or county and they would have the flexibility to use the money for any type of service that is needed, provided the budget does not exceed the fixed amount provider received. This amount would likely be 75% of what was previously spent on Emergency Medical Assistance for people in a particular geographic area or who are patients of a particular provider alliance. Rep. Abeler also referred to community health centers as examples of clinics who could coordinate services for the people enrolled in EMA. This proposal would include both documented and undocumented patients.

Regarding appeals: There are two types of appeals for nursing facility residents. First, nursing facilities were to apply on behalf of their residents to DHS for a limited exception coverage exemption tied to specific treatment and service needs. Facilities should be hearing back this week about whether their residents met the “threshold” and could remain in the facility with services being covered under the EMA limited exception. From the facilities who have contacted us to date, it appears many of these requests are being denied, which moves us to the second level of appeal. Individuals receiving the notice of service noncoverage late last year, regardless of where they are receiving their services, have the right to appeal changes to their benefits or eligibility. It is our understanding that DHS has continued benefits for anyone who has appealed their EMA termination of services. So far, we have not heard of any appeals being scheduled before February. Below is a script that can be used to assist patients to file appeals of the termination of their Emergency Medical Assistance benefits. There is a single phone number operated by Legal Aid that can be used as the contact point for information about and legal assistance with appeals.

We think it is still valuable for people to file appeals, even though coverage was discontinued on Monday. We have heard of examples of patients whose coverage was discontinued but then reinstated. Also, the more appeals that are filed, the more pressure there will be for the state to find a solution other than resolving each of the appeals individually on a case-by-case basis.

Response to patients asking about next steps once they receive the Hearing Notice from Minnesota Department of Human Services:

If you need help with the “Notice of Hearing”, call Legal Aid intake line for Hennepin County at 612-334-5970. Request “Spanish Please” or “Español Porfavor” and describe that you recently appealed the termination of your EMA. Have your insurance ID and case number ready, as well as the diagnostic reason for the Emergency Medical Assistance. Legal aid will help you from there. Provide Legal Aid with your Clinic/Health Care Provider telephone for any questions and requests.

Finally, the EMA Alliance, which we are a part of, is continuing to collect information. Please continue to notify us when you are notified about the status of your residents’ appeals. Please send me an email if you have an EMA patient who would potentially be willing to be a plaintiff in any litigation. All types of patients are needed, because this may be a class action and/or multiple individual lawsuits. One particular area of need is to find patients who are "lawfully residing" or "legally present" in the U.S. Examples include EMA patients who have a Parent Immigration Visa or who were Sponsored Immigrants but the sponsors or responsible parties are unavailable or unable to pay for their health care. Don't give us names or identifying information of the patients at this time.

Patti Cullen, CAE
952.851.2487
pcullen@careproviders.org

Our Sponsors