"Emergency Medical Condition" Given Generous Interpretation By Arizona Court

IMMIGRANTS & PUBLIC BENEFITS

Health Care

"EMERGENCY MEDICAL CONDITION" GIVEN GENEROUS INTERPRETATION BY ARIZONA COURT
Immigrants' Rights Update, Vol. 17, Issue 5 September 4, 2003

The Arizona Supreme Court recently interpreted Arizona's emergency Medicaid law to enable a patient's emergency Medicaid coverage to continue after his or her health condition is stabilized. This decision interprets the meaning of "emergency medical condition" more broadly than earlier decisions in other jurisdictions. Emergency Medicaid is available to qualifying individuals without regard to their immigration status, including undocumented persons. The court's decision has national significance because it interprets a definition of "emergency medical condition" in the federal Medicaid Act, incorporated into the Arizona law by reference.

The Medicaid Act defines "emergency medical condition" as:

a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including extreme pain) such that the absence of immediate medical attention could reasonably be expected to result in -
A) placing the patient's health in serious jeopardy,
B) serious impairment to bodily functions, or
C) serious dysfunction of any bodily organ or part.

The case before the Arizona Supreme Court specifically addressed whether an undocumented patient's emergency medical condition has ended when the patient's initial injury has stabilized to the point that the patient can be transferred from a hospital's acute care ward to a sub-acute ward.

The court concluded that the statutory definition, and the realities of medical treatment, did not permit the use of a bright-line test, such as a patient's transfer to a sub-acute ward, to determine when an emergency has ended. In doing so, the court disagreed with the federal Second Circuit Court of Appeals, which, in The Greenery Rehabilitation Group, Inc. v. Hammon, et al., 150 F.3d 226 (2d Cir. 1998), had concluded that a patient's emergency condition ends once the patient is stabilized. The Arizona court explained that "reliance on the notion of stabilization . . . fails to account for either the wide variety of emergency conditions or patients' responses to treatment."

Scottsdale Healthcare, Inc. v. Arizona Health Care Cost
Containment System Administration, 2003 Ariz. LEXIS 108 (Aug. 21, 2003).