What is the Alien Emergency Medical Program?
by: Northwest Justice Project
I am an immigrant and need medical assistance because I am very ill. The welfare office (DSHS) tells me I cannot get regular medical coupons. Is there a program that can help?
If you have a medical emergency, the federally funded Alien Emergency Medical (AEM) may be available to pay for services necessary to pay for that emergency.
Who is eligible?
Immigrants who are not eligible for regular medical coupons due to:
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their immigration status (they do not have an immigrant status known as "qualified" or they have a "qualified" immigrant status, but are in one of the groups in that category unable to receive non-emergency federal medical benefits for the first five years after they come to the US) or
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sponsor deeming (someone has filled out an affidavit of support Form I-864 on their behalf and it is still in effect so the "sponsor's" income and resources are considered by DSHS in determining financial eligibility for benefits)
Note: For a list of "qualified" immigrant status, see our publication titled Effective October 1, 2002, Some Immigrant Medical Programs Are Being Cut
If you are not eligible for regular medical coupons you must still be low-income, have an emergency medical condition, and be "categorically related" to the program.
To be categorically related you must be one of the following:
- a child under 18;
- a person in a family with dependent children;
- 65 and over;
- disabled (must be unable to work for at least one year), or
- pregnant.
What is an emergency medical condition?
An emergency medical condition is defined as --the sudden onset of a medical condition (including labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in
- Placing the patient's health in serious jeopardy
- Serious impairment to bodily functions ;or
- Serious dysfunction of any bodily organ or part.
What kinds of medical conditions fit into this definition?
The following conditions are considered by DSHS to meet the definition:
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Allergic Reaction Fever (Symptomatic) |
Hemorrhage, i.e., Bleeding |
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Amputation of Limb |
Hernia |
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Appendicitis |
Hypothermia |
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Asphyxia, i.e., Strangling/Drowning |
Infection, i.e., Cellulitis or Abscess of Any Body Part |
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Asthma, i.e. Acute |
Kidney Failure |
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Bowel Obstruction |
Kidney Infection |
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Bowel Perforation |
Laceration (artery, nerve) |
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Brain Injury |
Liver Failure |
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Burn Injury |
Malignant Hypertension |
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Cancer Surgery with Radiation Therapy and Chemotherapy |
Mental Breakdown |
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Cardiac Arrest |
Meningitis |
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Chest Pain |
Motor Vehicle Trauma |
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Coma Concussion |
Pancreatitis |
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Convulsion |
Peptic Ulcer (Bleeding, etc) |
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Deep Vein Thrombosis |
Poisoning |
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Depression (Major) |
Pneumonia |
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Diabetes Out of Control |
Collapsed Lung |
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Dislocation of Joints |
Pregnancy (labor/delivery) |
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Ectopic Pregnancy |
Respiratory Failure |
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Electrocution |
Seizures |
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Eye Injury |
Shock |
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Fainting |
Sunstroke |
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Fracture, i.e., Broken Bones |
Stroke |
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Gangrene |
Suicidal Ideation |
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Gallbladder infection |
Wounds resulting from Trauma
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Gallstones |
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Heart Failure |
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Heart Attack |
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NOTE: In addition, individuals requiring nursing home level of care or COPES meet the definition of having an emergency medical condition.
What if the condition I have is not on this list?
Conditions not on the list may be considered an emergency, but will need documentation from a health care provider. Show your doctor this brochure and ask her to explain why your health problem is an emergency. Give that letter to the welfare office when you apply.
Is this program available more than once a year?
Yes. Unlike the Limited Casualty Program Medically Indigent (LCPMI) program which is only available once a year, the Alien Emergency Medical Program is available as often as you have an emergency condition that qualifies. You will be issued coupons to pay for the emergency for three months. If you still need coupons--for the same emergency or a different one--you can reapply.
How do I get information on my medical condition if I am not seeing a doctor?
The welfare office does not have to pay for evaluations of an emergency condition so most applicants will have to go to a community clinic or to the hospital to have the emergency diagnosed.
What if I am not in one of the categories of people eligible (children, families, 65 and over, pregnant or disabled) but I still have an emergency?
If you are between the age of 18 and 64 and are not disabled or pregnant and have no dependents, you can still get help if you are low income and need emergency care. The state Limited Casualty Program Medically Indigent (apply at the welfare office) will pay for hospital based services after a $2000 "deductible." Hospital Charity Care regulations prohibit hospitals from billing patients earning less than 100% of federal poverty guidelines for necessary medical services received and will usually take care of the $2000 deductible.
What should I do if I apply for these programs and am denied?
You can request a fair hearing and contact a legal services lawyer for advice. For more information on fair hearings see our publication Representing Yourself at a Fair Hearing.
Where can I find the rules that describe the Alien Emergency Medical program?
You may find the rules in the Washington Administrative Code (WAC388-438-0110) and on the internet at http://www1.dshs.wa.gov/ESA/EAZManual/Sections/EA_AlienMedical.htm.
This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice.
This information is current as of the date of its printing, November 2003.
© 2003 Northwest Justice Project.
1-888-201-1014, TTY 1-888-201-9737
(Permission for copying and distribution granted to the Washington State Access to Justice Network and individuals for non-commercial use only.)
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