Emergency Medical Coverage for Noncitizens
In order for a noncitizen to qualify for emergency medical coverage: 1) they must qualify as a noncitizen and 2) their condition must qualify as an emergency medical condition. The decision for coverage is made by the Illinois Department of Human Services (DHS). There is a different analysis for persons with End Stage Renal Disease (ESRD) and pregnant women (both discussed below) but the majority of cases are analyzed by the above two elements.
Who is Eligible
Who qualifies as a noncitizen?
In order for a person to be considered for emergency medical coverage as a noncitizen, they must:
- Be a noncitizen who does not meet immigration status requirements, and
- Meet all other medical assistance eligibility requirements including Illinois residency.
What qualifies as an emergency medical condition?
Emergency medical conditions are very limited. Under DHS’ analysis, an emergency medical condition:
- Occurs suddenly and unexpectedly,
- Is caused by injury or illness, and
Requires immediate medical attention to prevent: serious jeopardy to patient's health, or serious impairment to bodily functions or parts.
Examples of what qualifies as emergency Medical conditions
Examples of emergency medical conditions are as follows:
- Treatment in an emergency room
- Treatment in a critical care unit or intensive care unit
Examples of what does not qualify as emergency medical conditions
Examples of what does not qualify as an emergency medical condition include:
- Chronic conditions
- Terminal illnesses
- Organ transplants and related services such as anti-rejection drugs
Need for long term care services
An exception to this rule is if the person has a need related to another emergency medical condition. There must always be a qualifying emergency medical condition in order to receive coverage.
Limitations on coverage
There are some limitations to the coverage that may be provided to noncitizens. These include:
- Coverage cannot be for more than 30 consecutive days unless DHS/HFS extends coverage.
- Eligibility for payment of services lasts only until the emergency condition is stabilized.
- Coverage for an emergency medical condition can only be authorized after the services are provided.
- Eligibility cannot be authorized for a future period of time.
- Only one person can be approved at a time. This means if a family receives care, they each need their own application.
To Apply For
Physician Responsibilities if patient applies for emergency medical coverage
If a patient requests emergency medical coverage, it is the physician’s responsibility to fill out Form 3801. On the form, the physician must specify:
- The diagnosis or condition requiring treatment,
- The onset date, and
- The date the patient was stabilized.
If the physician fails to complete the form or does not provide all of the needed information, the patient’s application is denied. Reports from nonmedical sources such as billing companies or agents are not acceptable. The patient needs Form 3801 completely filled out by their physician.
Patients with ESRD
ESRD is considered an emergency medical condition. Coverage is limited to renal dialysis services and unlike other emergency medical conditions, the case can be approved on an ongoing basis. Form 3801 is not required to approve an ESRD case for renal dialysis services. A statement from the attending physician that the person is receiving ESRD services is sufficient.
Noncitizen Pregnant Women
DHS does not authorize emergency medical coverage for noncitizen pregnant women. Pregnant women may qualify for benefits under the Family Assist, FamilyCare Assist or Moms and Babies programs.