MedicaidCoverageHigh impact
MAB2026083101
Pennsylvania Medicaid (DHS)·PA·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Sep 1, 2026
Summary
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.
Action Required
DEADLINE: Before October 1, 2026 – Billing team and providers must: (1) Update EVS eligibility verification process to recognize the EMA-only message for affected noncitizens; (2) Train all billing staff on the updated PA 1917 Form and submit initial EMA eligibility determinations to County Assistance Offices for new noncitizen patients; (3) Configure billing system to REQUIRE emergency admission type code '1' (Block 14) on all UB-04/837 Institutional claims for EMA patients, and emergency indicator 'Y' (Block 24c EMG) on all CMS-1500/837 Professional claims for EMA services; (4) Implement claim denial prevention by adding validation rules in billing software to reject EMA claims missing these required fields before submission; (5) Update patient intake forms and provider encounter templates to flag noncitizen status and remind clinicians to document emergency medical conditions; (6) Create billing denial tracking for EMA claims submitted without proper emergency coding to identify and correct patterns; (7) Review service lists to identify and exclude non-covered services (preventive, screening, vaccinations, non-emergency dental/vision, family planning, routine antepartum/postpartum, chiropractic, hospice, solid organ transplants) from EMA billing; (8) Establish process to verify GA state-funded coverage as alternative for eligible patients. CONSEQUENCE: Claims for EMA services without proper emergency admission type coding will be automatically denied.