Dennis A. Brebner & Associates has been a leader in the State of Illinois in fighting unfair denials of alien emergency Medicaid by the Illinois Department of Human Services.  These denials have deprived medical providers of millions of dollars in Medicaid reimbursement for patients they were required to treat under the Emergency Medical Treatment & Active Labor Act (EMTALA).

The firm recently challenged the states “sudden onset” requirement in 2nd District Appellate Court. In Elvira Arellano v. Illinois Department of Human Services et.al. , the court ruled that the sudden onset language that the Department of Human Services added to the federal Medicaid regulation  which Illinois’ regulation  mirrors, impermissibly modifies the federal Medicaid statute , which does not contain the sudden onset language and cannot be enforced.

Brenda Manning, co-counsel on the Arellano case said, “I would say the vast majority of our Alien Emergency (AE) cases in Illinois are denied due to lack of sudden onset because anyone who has symptoms for even a day or two before seeking treatment is denied due to lack of sudden onset, meaning the State is pretty much restricting AE to trauma type cases. After being granted an extension of time to appeal, the Attorney General’s Office has decided not to appeal this to the Illinois Supreme Court.”

Dennis A. Brebner & Associates has another AE case pending in the 3rd District Appellate Court.   In that case, a patient was denied coverage for a common medical condition that often requires surgical intervention, on the basis that she had symptoms for two to three days prior to seeking medical treatment and that her condition did not “require immediate medical attention to prevent jeopardy to her health or serious impairment to bodily functions or parts.”  The case challenges the application of this standard, which is taken from the Department’s policy manual , as it is overly restrictive when compared to the federal Medicaid statute, which uses a reasonableness standard.  The case also alleges that the Department’s policy is so far off from the federal standard, which clearly dictates that the emergency is to be assessed at the time the patient presents for treatment, that the Department is engaging in a hindsight methodology in evaluating AE cases that flies in the face of EMTALA and questions the judgment of emergency room physicians.

Read the AE Case  2-09-0581 here.