New York Medicaid Program
CMS has informedNew York officials that chemotherapy does not qualify for a provisionof Medicaid that allows coverage for emergency services forundocumented immigrants and other noncitizens, a decision that "setsthe stage for a battle between the state and federal governments overhow medical emergencies are defined," the New York Timesreports. The provision specifically excludes coverage for organtransplants but leaves to states the determination of whether otherprocedures qualify as emergency services, and states and courts havefought over the issue for years without a definitive resolution.
New York Health Insurance
According to the Times,the CMS decision, reached last month after the conclusion of a federalaudit of the New York Medicaid program that began in 2004, comes "amida fierce national debate on providing medical care to immigrants," withstate officials and critics "saying this latest move is one moreindication of the Bush administration's efforts to exclude theuninsured from public health services." New York officials on Friday ina letter to CMS protested the decision on the grounds that physicians,not the federal government, should determine when chemotherapy isnecessary.
Comments
New York Health CommissionerRichard Daines said, "There are clearly situations that we consideremergencies where we need to give people chemotherapy," adding, "To saythey don't qualify is self-defeating in that those situations willeventually become emergencies."
CMS officials declined to discuss the issue, but Dennis Smith, director of the Center for Medicaid and State Operationsat the agency, in a statement said, "Longstanding interpretations bythe agency have been that emergency Medicaid benefits are to coveremergencies."
The number of other state Medicaid programs thatcover chemotherapy for undocumented immigrants remains undeterminedbecause "all emergency services are generally lumped together in stateMedicaid reports," but other states have "been challenged on emergencyMedicaid claims," the Times reports (Kershaw, New York Times, 9/22).
Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation. 2007 Advisory BoardCompany and Kaiser Family Foundation. All rights reserved.