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Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023.

Enrollment in the Health Benefits for Immigrant Seniors (HBIS) program will be temporarily paused effective Nov. 6, 2023.

Provider Notice Issued 06/24/2022

Date:   June 24,2022

To:       All Medical Assistance Program Providers

Re:      Emergency Medical Coverage for Persons Not Meeting Immigration Status with COVID-19 Diagnosis


This notice details the requirements for extending emergency medical coverage for persons aged 19 and older who do not meet immigration status and have a COVID-19 diagnosis or suspected diagnosis.
Emergency medical coverage for a person with a COVID-19 diagnosis or suspected diagnosis is initially authorized for 60 days. The coverage period begins the earlier of:

  • The date of COVID-19 diagnosis or suspected diagnosis on a completed HFS 3801 or other documentation; or
  • The date the emergency medical application is received by the Department of Human Services or the Department of Healthcare and Family Services

Providers requesting coverage for a COVID-19 related individual must email the application to

If additional coverage is needed beyond the initial 60 days, the provider must email a request for the extension.

If extended coverage is needed beyond 120 days, the provider must email the request to the address above. Providers may request continued extended coverage at 60-day intervals. The following medical documentation is required:

  • Facility name providing service
  • Attending physician contact information
  • Physician's statement identifying the dates of service being reviewed (beyond the 120th day through the end of the COVID-19 illness/treatment)
  • The admission history and current physical examination from the current facility
  • 1-2 page clearly readable summary of care delivered at the facility including a plan for further care
  • Copies of all progress notes and test results within the past one week, and
  • HFS 3801 Report of Medical Treatment (if available).

Questions regarding this notice may be directed to the Bureau of All Kids at 866-255-5437.

Kelly Cunningham, Administrator
Division of Medical Programs