TMPPM 2009 > Provider Information > Client Eligibility > Restricted Medicaid Coverage

4.3.1 Emergency Only

The word "EMERGENCY" on the form indicates the client is restricted to coverage for an emergency medical condition. "Emergency medical condition" is defined in "Exceptions to Limited Status" on page 4-7.

Certification for emergency Medicaid occurs after the fact. This coverage is retroactive and limited to the specific dates of service of the emergency.

Clients limited to emergency care are not eligible for family planning, THSteps, or THSteps-Comprehensive Care Program (THSteps-CCP) benefits. Only services directly related to the emergency or life-threatening situations are covered.

Undocumented aliens and aliens with a nonqualifying entry status are identified for limited Medicaid eligibility by the classification of type programs (TPs) 30, 31, 32, 33, 34, and 35. Under Texas Medicaid, undocumented aliens are only eligible for emergency services, including emergency labor and delivery.

Any service provided after the emergency condition is stabilized is not payable.

If a client is not eligible for Medicaid and is seeking family planning services, refer the client to one of the clinics listed on the DSHS website at www.dshs.state.tx.us/famplan.