Find information about the limited coverage available to non-citizens under Apple Health (Medicaid).
The Alien Emergency Medical (AEM) Program is coverage for individuals who do not meet citizenship or immigration status requirements, or for qualified individuals who have not met the 5-year immigration bar, and have a qualifying medical condition.
- The individual must be categorically relatable to a Medicaid program, but not eligible for the Medicaid program solely due to immigration status requirements (which program an individual is related to determines whether they follow the MAGI or Classic Medicaid eligibility rules and application processing); and
- Have a qualifying emergency medical condition (must have or need at least one of the following):
- A qualifying emergent medical condition such as emergency room care, inpatient hospital admission, or outpatient hospital surgery.
- A cancer treatment plan.
- Dialysis treatment.
- Anti-rejection medication for an organ transplant.
- Long-term Care (LTC) services (prior approval required).
Below is a summary of the three Washington Administrative Codes that cover Alien Medical Programs:
- 182-507-0115: Alien Emergency Medical (AEM) – The qualifying services must be provided in a hospital setting (inpatient, outpatient surgery, emergency room) that includes evaluation and management visits by a physician and be needed to treat the emergency medical condition. Certification is limited to the dates on which the qualifying services were provided.
- 182-507-0120: Alien Medical for Dialysis and Cancer Treatment – The qualifying services must be needed to treat the qualifying condition of cancer, acute renal failure, or end stage renal disease, or be anti-rejection medication. These services do not need to be provided in a hospital setting.
- 182-507-0125: Alien Nursing Facility Program – The applicant must meet all other eligibility factors for nursing home placement and receive prior authorization by the Aging & Long-Term Support Administration (ALTSA). This program is subject to caseload limits.
Income and resource limits are the same as for the program to which the AEM applications are categorically relatable. See Apply for or renew coverage for more details.