G-7300, Prior Coverage for Aliens

Revision 21-3; Effective September 1, 2021

A person ineligible for Medicaid due to undocumented status or not having an appropriate alien status may be eligible for Medicaid to cover an emergency medical condition in:

  • the three months prior to the month of application only;
  • the month of application only; or
  • the month of application and up to three prior months.

More than one emergency medical period can be reported in the above time frames. Use Form H3038, Emergency Medical Services Certification, to verify treatment for an emergency medical condition and the dates of the emergency period. A new Form H3038 is needed for each emergency medical period.

The Form H3038 must:

  • indicate the begin and end dates of the emergency condition;
  • have the handwritten signature of the medical practitioner who provided the emergency treatment; and
  • be signed and dated by the applicant on page 2.

Note: A stamped or electronic signature of the attending practitioner is not acceptable.

A medical practitioner is a person who holds a license to practice medicine, including the following:

  • physician (MD);
  • osteopathic medical physician (DO);
  • advance nurse practitioner (ANP); or
  • registered nurse (RN).

Note: A licensed practical nurse (LPN), a licensed vocational nurse (LVN), or a midwife do not meet the definition of medical practitioner.

Verification of unpaid medical bills is not required for prior coverage for emergency Medicaid. Provide Medicaid coverage for the duration of the emergency period as indicated on the Form H3038.