High impact
MAB2026083101
Pennsylvania Medicaid (DHS)·Effective Oct 1, 2026
Effective October 1, 2026, certain qualified noncitizens will lose full Medicaid coverage and become eligible only for Emergency Medical Assistance (EMA) to treat acute emergency conditions. Billing teams must now verify EMA eligibility in EVS, complete the updated PA 1917 Form for initial determinations, and mark claims with emergency admission type codes (Block 14 = '1' for institutional claims, Block 24c EMG = 'Y' for professional claims) or face claim denials. Services like preventive care, vaccinations, dental, vision, and routine antepartum/postpartum care are excluded from EMA coverage.