A snapshot of Georgia: Emergency Medical Assistance, a program of the Georgia Department of Community Health [Jan. 2008]

A Program Of The Georgia Department Of Community Health
A SNAPSHOT OF GEORGIA
Emergency medical assistance

Overview

Emergency Medical Assistance (EMA) is a federally mandated program which provides medical coverage to individuals who meet all requirements for a Medicaid Class of Assistance (COA) except for citizenship requirements, and who have received an emergency medical service.

Program Description

EMA covers persons who are ineligible for Medicaid due to not being United States citizens or other reasons. This population could include immigrants who are aged, blind, disabled, pregnant women, children, or parents with dependent children.

These persons may apply to get assistance to pay bills that were incurred due to a medical emergency. EMA is not an ongoing coverage plan. Applicants must apply for this service as each medical emergency is incurred. In addition, EMA may not pay all expenses for care, since it only covers the care that treats the immediate emergency.

Annual Expenditures for Emergency Medical Assistance FY 2002 - FY 2006*

Fiscal Year Unique Patients Net Payment PMPY1

FY 2003

17,778

$78,699,180.65 $4,426.77

FY 2004

19,647

$94,252,894.83 $4,797.32

FY 2005

22,609

$108,286,816.85 $4,789.54

FY 2006

22,574

$102,720,723.86 $4,550.40

FY 2007

19,092

$79,362,009.15 $4,156.82

Definition of an Emergency

1PMPY stands for Per Member Per Year

An emergency is defined as the onset acute symptoms of sufficient severity such that the absence of immediate medical attention could result in:
nPlacing the patient's health in serious

FY 2006 Expenditures for Emergency Medical Assistance Pregnancy Deliveries Only*

Fiscal Year

Patients

Net Payment

FY 2007

17,245

$55,567,221.47

jeopardy;

nSerious impairment to bodily functions; or

nSerious dysfunction of any bodily organ or part.

In addition, all labor and delivery is considered an emergency by federal definition. Care and

services can not be related to an organ transplant procedure or routine prenatal or

postpartum care.

Member Eligibility

A Medicaid Eligibility worker will review an application to determine if the client is eligible for a Medicaid COA. If a person is eligible for COA but not a citizen, he may be eligible to receive EMA. The clinical information is then reviewed by an external clinical review organization to determine whether the care was emergent, before a final decision is made.

2 Peachtree Street, Atlanta, Ga 30303 w www.dch.georgia.gov

January 2008