Renal Dialysis: Court Says Medicaid Must Pay For Alien's Continuing Care After Emergency Episode

Renal Dialysis: Court Says Medicaid Must Pay For Alien's Continuing Care After Emergency Episode

Legal Eagle Eye Newsletter for the Nursing Profession

February 1997

Quick Summary: Ongoing outpatient renal dialysis following an emergency episode of acute renal failure is covered by Medicaid as treatment for an emergency medical condition.

Medicaid, in general, does not pay benefits for an undocumented alien's medical care.

   Medicaid does pay for an alien’s medical care for an emergency medical condition.

   Continuing treatment for a medical condition which arose as an emergency is covered by Medicaid as care for an emergency medical condition.

   Payment for medical care for an emergency medical condition is not limited to the emergency room or to the time frame while the acute symptoms still exist, but must continue as long as the absence of immediate care would result in serious jeopardy to the patient from the condition.

This hospital treated the patient on a charitable basis, but should have been reimbursed by Medicaid. SUPERIOR COURT OF CONNECTICUT, 1995.

An emergency medical condition is defined by law in the U.S. Social Security Act as:

A medical condition (including emergency labor and delivery) manifesting itself by symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in - (A) placing the patient’s health in serious jeopardy, (B) serious impairment to bodily functions, or (C) serious dysfunction of any bodily organ or part.

The Superior Court of Connecticut recently ruled, after reviewing the latest court case precedents from New York, California and Arizona, that ongoing outpatient renal dialysis following an emergency episode of acute renal failure is treatment for an emergency medical condition.

Outpatient dialysis for end-stage renal disease is covered by Medicaid for an undocumented alien as treatment for an emergency medical condition, the court ruled.

The court praised the hospital (Yale-New Haven Hospital) for treating this patient on a charitable basis, which should not have been necessary, as the state Medicaid agency should have paid.

In general, Medicaid simply does not pay benefits for medical care for undocumented aliens, such as this man who came to the U.S. from India under a now-expired student visa. There is an exception under Medicaid that Medicaid will pay for emergency medical care, however.

Emergency care is defined not only as care rendered while there are acute symptoms in the emergency room. Emergency medical care covered by Medicaid includes continuing care, so long as it is for a condition which manifested itself as a medical emergency, and continuing care is necessary to prevent immediate jeopardy to the patient. Gaddam vs. Rowe, 684 A. 2d 286 (Conn. Super., 1995).