(a) FFP for services. FFP is available for services provided to aliens described in this section which are necessary to treat an emergency medical condition as defined in paragraphs (b)(1) and (c) or services for pregnant women described in paragraph (b)(2).
(b) Legalized aliens eligible only for emergency services and services for pregnant women. Aliens granted lawful temporary resident status, or lawful permanent resident status under sections 245A, 210 or 210A of the Immigration and Nationality Act, who are not in one of the exempt groups described in §§ 435.406(a)(3) and 436.406(a)(3) and who meet all other requirements for Medicaid will be eligible for the following services—
(1) Emergency services required after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:
(i) Placing the patient's health in serious jeopardy;
(ii) Serious impairment to bodily functions; or
(iii) Serious dysfunction of any bodily organ or part.
(2) Services for pregnant women which are included in the approved State plan. These services include routine prenatal care, labor and delivery, and routine post-partum care. States, at their option, may provide additional plan services for the treatment of conditions which may complicate the pregnancy or delivery.
(c) Effective January 1, 1987, aliens who are not lawfully admitted for permanent residence in the United States or permanently residing in the United States under the color of law must receive the services necessary to treat the condition defined in paragraph (1) of this section if—
(1) The alien has, after sudden onset, a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:
(i) Placing the patient's health in serious jeopardy;
(ii) Serious impairment to bodily functions; or
(iii) Serious dysfunction of any bodily organ or part, and
(2) The alien otherwise meets the requirements in §§ 435.406(c) and 436.406(c) of this subpart.
[55 FR 36823, Sept. 7, 1990; 56 FR 10807, Mar. 14, 1991]
Notes of Decisions
Szewczyk v. Dep't of Soc. Servs., 881 A.2d 259 (Conn. 2005).
· cites it 12× “Indeed, in determining that the federal regulation, 42 C.F.R. § 440.255 , [14] or the legislative history do not require a different definition of the term "emergency medical condition," the court concluded that "our review of the plain meaning of § 1396b (v)(3) ends our inquiry.”
Arellano v. Dep't of Human Servs., 943 N.E.2d 631 (Ill. App. Ct. 2010).
· cites it 3× “” 42 C.F.R. §440.255 (c) (2006). The Illinois regulation provides as follows: “Notwithstanding [the regulation’s general ban on assistance to non-citizens], any non-citizen is eligible for medical assistance if the non-citizen otherwise meets the income, asset and categorical…”
Szewczyk v. Dep't of Soc. Servs., 822 A.2d 957 (Conn. App. Ct. 2003).
· cites it 2× “found at 42 C.F.R. § 440.255 (b) (1) . . . provides that aliens are entitled to Medicaid coverage for [e]mergency services required after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the…”
Greenery Rehab. Grp., Inc. v. Hammon, 150 F.3d 226 (2d Cir. 1998).
· cites it 5× “§ 1396b(v)(3), 42 C.F.R. § 440.255 (b)(1) and corresponding New York State regulations, after initial treatment of the injuries.”
Odi v. Alexander, 378 F. Supp. 3d 365 (E.D. Pa. 2019).
· cites it 2× “§ 1396b(v)(3) ; see also 42 C.F.R. § 440.255 (same) ; 55 Pa. Code § 150.”
Greenery Rehab. Grp., Inc. v. Hammon, 893 F. Supp. 1195 (N.D.N.Y. 1995).
· cites it 4× “As per the discussion at trial, it appears that defendants would offer Tomlinson’s testimony to explain the meaning of the applicable federal regulation, 42 C.F.R. § 440.255 . At the end of trial, the parties were directed to submit a two-page letter discussing the legal…”
Norwood Hosp. v. Comm'r of Pub. Welfare, 627 N.E.2d 914 (Mass. 1994).
· cites it 3× “600, the question whether Addley is eligible for medical assistance should be considered in light of 42 C.F.R. § 440.255 (c) (1) (1990), which limits medical assistance to undocumented aliens to circumstances in which the emergency medical condition has a “sudden onset.”
Luna v. Div. of Soc. Servs., 589 S.E.2d 917 (N.C. Ct. App. 2004).
“42 C.F.R. § 440.255 (b). A state Medicaid plan must conform to these requirements.”
Texas v. United States, 328 F. Supp. 3d 662 (S.D. Tex. 2018).
“In other words, because DACA increases the total number of aliens in the States by disincentivizing those already present from leaving, the States must provide more of these social services, which cost more.”
Salem Hosp. v. Comm'r of Pub. Welfare, 574 N.E.2d 385 (Mass. 1991).
“Furthermore, 42 C.F.R. § 440.255 provides that “[ejffective January 1, 1987, aliens who are not lawfully admitted for permanent residence in the United States or permanently residing in the United States under the color of law” must be eligible to receive Medicaid for treatment…”
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