MedicaidAdministrativeMedium impact
MAB2023041302
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Apr 13, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania updated the Emergency Medical Condition Information Eligibility Form (PA 1917) to streamline eligibility determination for Emergency Medical Assistance for non-citizens. The updated form now includes pre-approved conditions like high-risk pregnancy, Type I diabetes under 21, diabetic emergencies, renal failure requiring dialysis, recent fractures, hypertensive emergencies, unstable seizure disorders, active cancer treatment, ventilator dependency, labor/delivery, and acute psychiatric hospitalization.
Action Required
Immediately: All Pennsylvania providers must begin using the updated PA 1917 Form for non-citizens seeking Emergency Medical Assistance approval. For patients with pre-approved conditions listed in Section I, select the appropriate diagnosis box, describe treatment plan, and sign the form. For unlisted conditions, select 'any condition not described above' and include supporting documentation (hospital records, ER visits, diagnostic testing). Submit completed forms to County Assistance Office for eligibility determination.