New York Medicaid Program Cannot Cover Cancer Treatments for Immigrants, According to CMSCMS has informed New York officials that chemotherapy does not qualify for a provision of Medicaid that allows coverage for emergency services for undocumented immigrants and other noncitizens, a decision that "sets the stage for a battle between the state and federal governments over how medical emergencies are defined," the New York Times reports. The provision specifically excludes coverage for organ transplants but leaves to states the determination of whether other procedures qualify as emergency services, and states and courts have fought over the issue for years without a definitive resolution.
According to the Times, the CMS decision, reached last month after the conclusion of a federal audit of the New York Medicaid program that began in 2004, comes "amid a fierce national debate on providing medical care to immigrants," with state officials and critics "saying this latest move is one more indication of the Bush administration's efforts to exclude the uninsured from public health services." New York officials on Friday in a letter to CMS protested the decision on the grounds that physicians, not the federal government, should determine when chemotherapy is necessary.
New York Health Commissioner Richard Daines said, "There are clearly situations that we consider emergencies where we need to give people chemotherapy," adding, "To say they don't qualify is self-defeating in that those situations will eventually become emergencies."
CMS officials declined to discuss the issue, but Dennis Smith, director of the Center for Medicaid and State Operations at the agency, in a statement said, "Longstanding interpretations by the agency have been that emergency Medicaid benefits are to cover emergencies."
The number of other state Medicaid programs that cover chemotherapy for undocumented immigrants remains undetermined because "all emergency services are generally lumped together in state Medicaid reports," but other states have "been challenged on emergency Medicaid claims," the Times reports (Kershaw, New York Times, 9/22).