What defines a medical emergency?

An article in the New York Times on September 22 discusses the recent move by the federal government to remove coverage for chemotherapy through the Medicaid program for illegal immigrants seeking emergency cancer services. The existing provision for illegal immigrants through Medicaid allows for emergency coverage only, however up until now, the definition of “medical emergency” was left up for the individual states to decide. The statute clearly states that routine care for nonresidents and illegal immigrants is not covered, but the only procedures that are specifically excluded are transplantations.

Some states define a medical emergency as when it is not possible to schedule an appointment for treatment of an injury, illness, or disease. Other states define it as any condition that may lead to an emergency or lead to death without treatment. New York state officials, who are fighting the federal government’s decision, argue that certain conditions such as diseases of the brain, spinal cord, and bone marrow disease could require immediate chemotherapy. In addition, chemotherapy can be used to cure, control, and/or ease cancer symptoms. If the measures typically used to treat these conditions and cancers for illegal immigrants and nonresidents, the risks for complications or mortality could be imminent.

But where is the line for emergency coverage to be drawn and is it worth excluding chemotherapy coverage when it is only a small portion of the state’s Medicaid budget? The article mentions that the majority of state Medicaid cost stems from care for pregenant women, labor, and delivery. A study of emergency Medicaid services in North Carolina found that spending increased by 28% between 2001 and 2004. However, the emergency medical services cost accounted for less than 1% of the total Medicaid expenditures.

Source: http://www.nytimes.com/2007/09/22/washington/22emergency.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1190735537-WczZKe0aazug9Mh7lST1Kg