WAC 388-438-0110 The Alien emergency medical (AEM) program.

1. The alien emergency medical (AEM) program is a required federally funded program. It is for aliens who are ineligible for other Medicaid programs, due to the citizenship or alien status requirements described in WAC 388-424-0010.

2. Except for the social security number, citizenship, or alien status requirements, an alien must meet categorical Medicaid eligibility requirements as described in:

   1. WAC 388-505-0110, for an SSI-related person;

   2. WAC 388-505-0220, for family medical programs;

   3. WAC 388-505-0210, for a child under the age of nineteen; or

   4. WAC 388-523-0100, for medical extensions.

3. When an alien has monthly income that exceeds the CN medical standards, the department will consider AEM medically needy coverage for children or for adults who are age sixty-five or over or who meet SSI disability criteria. See WAC 388-519-0100.

4. To qualify for the AEM program, the alien must meet one of the criteria described in subsection (2) of this section a qualifying emergency medical condition as described in WAC 388-500-0005.

5. The alien's date of arrival in the United States is not used when determining eligibility for the AEM program.

6. The department does not deem a sponsor's income and resources as available to the client when determining eligibility for the AEM program. The department counts only the income and resources a sponsor makes available to the client.

7. Under the AEM program, covered services are limited to those medical services necessary for treatment of the person's emergency medical condition. The following services are not covered:

   1. Organ transplants and related services;

   2. Prenatal care, except labor and delivery;

   3. School-based services;

   4. Personal care services;

   5. Waiver services;

   6. Nursing facility services, unless they are approved by the department's medical consultant; and

   7. Hospice services, unless they are approved by the department's medical consultant.

8. The medical service limitations and exclusions described in subsection (7) also apply under the MN program.

9. A person determined eligible for the AEM program is certified for three months. The number of three-month certification periods is not limited, but, the person must continue to meet eligibility criteria in subsection (2) and (4) of this section.

10. A person is not eligible for the AEM program if that person entered the state specifically to obtain medical care.