Provider letter edited 10-26-2009
Bucket one final AEM client letter revision
Bucket two AEM client letter Final
New Information about Cuts to the Alien Emergency Medicaid (AEM) Program
The Alien Emergency Medicaid (AEM) program is for people who would be eligible for other Medicaid programs except for their immigration status.
As of November 1, 2009, DSHS changed the program to provide fewer services to fewer people. This is a painful policy change that will have a life-threatening impact on some clients.
NOTE - these changes will not affect pregnant women or children under 19 years of age who are on Apple Health for Kids, as services for these people are still covered by the state as part of the Apple Health package.
The following is a brief summary of the changes, effective November 1st.
* The AEM program will only cover emergency services provided in a hospital setting - emergency room, outpatient surgery or inpatient hospital admission - and emergency transportation and services (see "Bucket 1" letter).
Emergency treatment in community health centers, freestanding urgent care clinics, outpatient settings, and other locations will no longer be covered. Services provided as follow-up to hospital care will no longer be covered. Generally, medications and supplies (such as for diabetic care) will no longer be covered.
This limited emergency coverage is now being referred to at the "Federal Funded Alien Emergency Medical Program" or "Program 1." DSHS says that patients in Program 1 will largely be retroactively certified. Certification periods will generally be limited to one month, unless longer hospitalization is clearly needed.
* Limited state funding is available for kidney dialysis and cancer patients, and to cover anti-rejection medications for people who have received transplants. This coverage is being referred to as the "State
Funded Alien Emergency Medical Program" or "Program 2."
This program will cover a specified list of services needed to treat cancer or kidney disease that requires dialysis (see "Bucket 2" letters, except the "Home Care" letter referred to below). The program is not limited to care in a hospital and covers more than Program 1. Prior authorization from DSHS is required for a number of these services, including: hospice, home health, DME, oxygen, respiratory & intravenous
(IV) therapy, and dialysis for acute renal disease.
This program will also cover anti-rejection medications for people who have received transplants. This includes management of medication, care management as it relates to the transplanted organ, and dialysis if needed. Organ transplants themselves are not covered through this program.
* Long-term care will continue to be covered for a small number of nursing home level of care clients statewide. These services will now be referred to as the "State Funded Nursing Facility Alien Emergency Medical Program" or "Program 3." A very small number of clients who receive nursing home level of care services in their homes will continue to be covered (see "Bucket 2 . . . Home Care" letter).
DSHS has sent the attached letters to clients currently eligible for AEM. Since the letters are not individualized denials, it may be difficult for a client to understand whether he or she will be affected. Advocates should advise clients of their right to appeal and receive continued assistance, where appropriate.
The state is not terminating certification periods early (certification periods are typically 3 months under the current AEM program). However, the new rules will be applied to coverage and authorization of services as of
November 1st. Our understanding is that providers billing for services have been notified of the changes (see attached "Provider Letter" and the DSHS Memo # 09-68, available at:
http://hrsa.dshs.wa.gov/download/Memos/2009Memos/09-68.pdf). If they do bill for non-covered services, the system has not yet been programmed to reject the bills outright because of the moratorium on ACES changes pending
the introduction of the new billing system, ProviderOne, now scheduled for January 2010.
Please contact NoHLA with questions or if you know of someone who is losing needed services as a result of these changes (206-325-6464 or nohla(at)nohla.org).
Solid Ground (206-694-6742 or 1-866-297-4300) and CLEAR (1-888-201-1014, 9:15am-12:15pm) attorneys are also available to help clients who are denied or billed for services due to these changes.