Aged, Blind, Disabled (ABD): How to Certify Alien Emergency Medical

Alien Emergency Medical cannot be certified until it is approved by LOCEU.
Refer to article ABD: How to Get Approval for Alien Emergency Services.
Alien Emergency Medical provides a medical benefit for only the days the client was in the hospital. FACS is not set up to certify the medical benefit for days instead of months. After the certification is fully processed, a Remedy ticket will need to be submitted so that the Help Desk will convert the certification period from months to days.
The client’s categorical relationship will affect how the medical benefit can be certified.

For AFDC categorical relationship:

  • the medical benefit cannot be certified before the first day of the month of application. Example: Jane Greystoke, who is not disabled but is the mother of one, was in the hospital from 02/25 through 03/03. The hospital sent in an application on 03/01. Even though she was in the hospital in February, policy does not allow the medical benefit to be certified before 03/01.

For ABD categorical relationship:

  • the medical benefit can be certified up to three months prior to the month of application. Example: Miguel Cervantes is unable to work due to a heart problem. He is in the hospital from 06/29 through 07/10. The hospital sends in an application on his behalf on 07/06. A Medical Social Summary is sent to LOCEU to make a disability decision along with the approval for emergency medical. LOCEU determined that Miguel is disabled, so the medical benefit can be certified the month before the month of application.

For additional details on asking LOCEU for a disability decision, refer to article ABD: Level of Care Evaluation Unit (LOCEU).

Example: Doug McKenzie is an undocumented alien with one child. He went to the emergency room on 04/15. The Indio Hospital submitted an application for him on 04/30. He was discharged from the hospital on 05/03.

MEDATS shows approval for emergency services.

MEDATS screen

Enter in all contact information on the Case Info tab.

Case Info tab

In the Household tab, add to the medical benefit the beginning of the month for which the client was approved or can be eligible. For Doug, that will be 04/01. The citizenship block must be coded undocumented alien.

Household tab

If applicable, enter any information, giving appropriate deductions in the Income and Resource Tabs.

In the Medical General tab, certify the medical benefit. Application date is when the PS-1 or initial request was received (04/30 for Doug). Effective months must be 99. The Certification Period is the number of months with days approved by LOCEU and/or the time that can be certified based on the categorical relationship. Doug is approved for days in April and May so he will be certified for 2 months. His application was received in April so he can be certified for both months.

Medical General tab

In the Medical Financial tab, Medical Application Reason can be “Short Term – Other Than Listed Above” or “Short Term, TEFRA or State Supplemental Application…”

Medical Financial tab

Once the certification is fully processed in FACS and you get the smiley face, a Remedy ticket will need to be submitted so the Help Desk will convert the certification period from months to days.

Remedy ticket screen

For additional information on submitting Remedy tickets refer to article AFS Help Desk (Remedy): How to Create a Remedy Ticket.

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