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2012 Texas Medicaid Provider Procedures Manual

Volume 1, General Information : Section 4: Client Eligibility : 4.4 Restricted Medicaid Coverage : 4.4.1 Emergency Only

4.4.1
The word “EMERGENCY” on the form indicates the client is restricted to coverage for an emergency medical condition.Emergency medical condition” is defined in subsection 4.4.2.2, “Exceptions to Limited Status” in this section.
Certification for emergency Medicaid occurs after the services have been provided. The coverage is retroactive and limited to the specific dates that the client was treated for the emergency medical condition.
Clients limited to emergency medical care are not eligible for family planning, THSteps, or Comprehensive Care Program (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 emergency Medicaid eligibility by the classification of type programs (TPs) 30, 31, 32, 33, 34, 35, and 36. Under Texas Medicaid, undocumented aliens are only eligible for emergency medical services, including emergency labor and delivery.
Any service provided after the emergency medical condition is stabilized is not a benefit.
If a client is not eligible for Medicaid and is seeking family planning services, providers may refer the client to one of the clinics listed on the DSHS website at www.dshs.state.tx.us/famplan.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.