MP MediPrimer

Edge Cases

Emergency Medicaid: Hospital Coverage Regardless of Immigration Status

You can be barred from regular Medicaid because of your immigration status and still have an emergency paid for. Here's what counts as an emergency, who qualifies, and what this coverage does not do.

Here's the short answer. Federal Medicaid law makes an exception for emergencies. Medicaid can pay to treat an emergency medical condition. That includes emergency labor and delivery. To qualify, you must meet the state's other Medicaid rules, like income and living in the state. You do not need an immigration status that qualifies for regular Medicaid. People often call this "Emergency Medicaid." It is not full health insurance. It pays only for care needed to treat the emergency. It never pays for anything related to an organ transplant. One more protection. Any hospital that takes Medicare and has an emergency room must check you and treat you in an emergency, including active labor. That's true whether or not you can pay.

In an emergency, go to the hospital first. You usually apply for Emergency Medicaid during or after the hospital visit. Hospital staff or your state Medicaid agency can help. Names and forms differ by state. Use our State Medicaid directory to find your agency.

Who qualifies for Emergency Medicaid

The federal rule sets three conditions. Medicaid pays for care for someone without a qualifying immigration status only if:

In plain terms: your immigration status is the only thing keeping you out of regular Medicaid. You still have to fit a Medicaid group in your state. That could be a pregnant person, a parent, a child, or a low-income adult in a state that expanded Medicaid. Your income has to be under that group's limit. Our Medicaid eligibility page explains those groups. Each state sets its own income limits and groups. The only way to know for sure is to ask your state Medicaid agency.

Undocumented immigrants can't buy a plan through the Health Insurance Marketplace. So for many families, Emergency Medicaid and community health centers are the main options. Lawfully present immigrants in the 5-year Medicaid waiting period may be able to get Marketplace coverage instead.

What counts as an "emergency medical condition"

The law defines it. An emergency medical condition has sudden, severe symptoms. Severe pain counts. Emergency labor and delivery count. The test is this: without immediate medical care, the condition could reasonably be expected to:

States and hospitals apply that test case by case. Have an ongoing, life-threatening condition? Ask your state agency whether its treatment can qualify. Don't assume either way.

What Emergency Medicaid pays for, and what it doesn't

Generally covered Not covered
Care necessary to treat the emergency medical condition itself Ongoing or routine care once the emergency is over, such as checkups, prescriptions, or follow-up visits, unless your state chooses to cover them
Emergency labor and delivery Anything related to an organ transplant
The emergency screening and stabilizing treatment a Medicare hospital must give in its emergency room Full Medicaid benefits: this is not a health plan you carry year-round

Ask your state agency how long an approval lasts, and whether a new emergency later on needs a new application.

Labor, delivery, and pregnancy

Emergency labor and delivery is written into the federal definition of an emergency medical condition. So childbirth can be covered even when nothing else is. Prenatal care is a different question. Federal law lets each state choose to cover pregnant women and children who are lawfully residing in the U.S. without the usual 5-year wait. Check whether your state has done that. Ask your state agency what pregnancy coverage it offers for your status. Our Medicaid and pregnancy page explains pregnancy coverage in general. CHIP covers children in families that earn too much for Medicaid.

The hospital's duty in an emergency

Whether or not you have coverage, a 1986 federal law called EMTALA protects you. Hospitals that take Medicare and offer emergency services must give you a medical screening exam when you ask for emergency care. That includes active labor. It applies whether or not you can pay. If you have an emergency medical condition, the hospital must give you stabilizing treatment. If it can't stabilize you, or you ask to be moved, it must arrange a proper transfer. Emergency Medicaid is about who pays the bill afterward. EMTALA is about getting treated in the first place.

Does applying hurt my immigration case?

HealthCare.gov says applying for or getting Medicaid or CHIP doesn't make you a "public charge." So it won't hurt your chances of getting a green card or citizenship. The one exception is long-term care in an institution, like a nursing facility, paid for by the government. Immigration rules can change. If you have a pending case, consider asking an immigration attorney or an accredited representative first. Nothing on this page is legal advice.

How to apply

  1. Ask the hospital. Ask the billing office whether it can help you apply for Medicaid, including emergency-only coverage.
  2. Contact your state Medicaid agency. Every state's contact information is at Medicaid.gov and in our State Medicaid directory. You can also apply through HealthCare.gov or the Marketplace Call Center at 1-800-318-2596 (TTY 1-855-889-4325). The Marketplace sends possible Medicaid cases to your state.
  3. Gather income and residency proof. You'll need to show that you meet the state's income limit and live in the state. Those rules still apply.
  4. Keep the bills and dates. Ask the state how far back the coverage can reach. Ask whether the hospital can bill Medicaid directly for the emergency.
  5. If you're denied, you can appeal. Medicaid decisions come with appeal rights. See Your Rights.

If you aren't eligible for any coverage, community health centers provide primary care on a sliding fee scale based on income. Free help with Medicaid questions is also available from your state agency and from local navigators. See Getting Help Paying.

Common questions

Do I need to be a citizen or have a green card to get Emergency Medicaid?

No. This coverage is for people who meet the state's income and residency rules but don't have a qualifying immigration status.

Will Emergency Medicaid pay for my prescriptions or follow-up visits?

Usually not. Federal law limits this coverage to care needed to treat the emergency. Ask your state agency what is included.

Can the hospital turn me away if I don't have insurance or papers?

A hospital that takes Medicare and has an emergency room must screen you. If you have an emergency medical condition, including active labor, it must treat you to stabilize you. That's true whether or not you can pay.

I'm a green card holder in the 5-year waiting period. Is Emergency Medicaid my only option?

Probably not. Qualified non-citizens in the 5-year waiting period may be able to get Marketplace coverage with savings based on income. Refugees and asylees have no waiting period at all. See The Marketplace (ACA).

Does Emergency Medicaid have anything to do with Medicare?

No. Medicare is a separate federal program. Its rules for immigrants depend mostly on work history and years of lawful residence. See Medicare for Immigrants and Green Card Holders.

Official sources

Verify before you act. MediPrimer is general educational information and is not affiliated with any agency or insurer. Program names, income limits, and what counts as an emergency are decided state by state. Federal immigration and Medicaid rules change. Confirm your situation with your state Medicaid agency. Nothing here is legal or immigration advice.