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Undocumented Aliens Receive Limited Medicaid Benefits

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Changes in federal Medicaid rules adopted in 1996 made most immigrants—including even legal permanent residents—ineligible for health care benefits. For immigrants in the country legitimately eligibility for Medicaid services is not available until they have been legal permanent residents for five years. Undocumented aliens, on the other hand, can only qualify for emergency medical care.

The limitation on Medicaid coverage for undocumented aliens arguably has more effect on hospitals than on the noncitizens themselves. Since hospitals are generally required to provide care for anyone they admit, regardless of citizenship status, the legal and financial problems often develop after the care has been provided and the hospital (or other health care provider) seeks reimbursement from Medicaid.

That scenario is exactly what played out in three related cases decided recently by the Arizona Supreme Court. In each case, Phoenix-area hospitals had provided care to undocumented aliens and sought reimbursement from AHCCCS, the Arizona Medicaid program. In each case AHCCCS acknowledged coverage for the emergency medical condition on admission, but denied coverage after each patient had been moved from acute care to a hospital rehabilitation unit.

AHCCCS maintained that its mandate was to provide emergency care only, and the fact that each patient had been stabilized medically (as evidenced by the move to a rehab unit) ended its liability. The hospitals argued that once AHCCCS acknowledged liability for a given patient’s care, it had to pay for that care until it was no longer medically necessary.

The Arizona Court of Appeals had ruled that once each patient’s medical condition had stabilized, Medicaid coverage should still be available if lack of medical care might lead to serious impairment of bodily functions or a serious health risk. The State Supreme Court disagreed, but remanded the cases for further fact-finding.

In the Supreme Court’s view, the important factual question is whether each patient still requires emergency medical care. That determination, in turn, depends on whether the patient’s condition is “acute” or “chronic.” Since the evidence at each trial had not focused on that question, the Court ordered further hearings to determine the nature of each patient’s condition. If the conditions remain “acute” even after transfer to the rehab unit, AHCCCS will be obliged to continue paying for the patient’s care. Scottsdale Healthcare, Inc., v. AHCCCS, August 21, 2003.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.