Wis. ForwardHealth Online Handbook, Hospice, Topic #277

Certain non-U.S. citizens who are not qualified aliens are eligible for services only in cases of acute emergency medical conditions.

Providers should use the appropriate diagnosis code to document the nature of the emergency.

An emergency medical condition is a medical condition manifesting itself by acute symptoms of such severity that one could

reasonably expect the absence of immediate medical attention to result in the following:

• Placing the person's health in serious jeopardy

• Serious impairment to bodily functions

• Serious dysfunction of any bodily organ or part

Due to federal regulations, BadgerCare Plus and Wisconsin Medicaid do not cover services for non-U.S. citizens who are not

qualified aliens related to routine prenatal or postpartum care, major organ transplants (for example, heart, liver), or ongoing

treatment for chronic conditions where there is no evidence of an acute emergent state. For the purposes of this policy, services

for ESRD (end-stage renal disease) and all labor and delivery are considered emergency services.

Note: Babies born to certain non-qualifying immigrants are eligible for Medicaid enrollment under the CEN (continuously eligible

newborn) option. However, babies born to women with incomes over 300% of the FPL (Federal Poverty Level) are not eligible

for CEN status. The baby may still qualify for BadgerCare Plus. These mothers should report the birth to the local agencies within

10 calendar days.

A provider who gives emergency care to a non-U.S. citizen should refer them to the income maintenance or tribal agency or

ForwardHealth outstation site for a determination of BadgerCare Plus enrollment. Providers may complete the Certification of

Emergency for Non-U.S. Citizens (F-01162 (02/2009)) form for clients to take to the income maintenance or tribal agency in

their county of residence where the BadgerCare Plus enrollment decision is made.

Providers should be aware that a client's enrollment does not guarantee that the services provided will be reimbursed by

BadgerCare Plus.