MDHHS Announces Changes to Emergency Services Only (ESO) Medicaid Coverage for Dialysis Services
JANUARY 12, 2022 – MIRC is pleased to share the announcement from the Michigan Department of Health and Human Services (MDHHS) that effective April 1, 2022, dialysis services for the treatment of End Stage Renal Disease (ESRD) will not be restricted to Emergency Departments for Emergency Services Only (ESO) Medicaid beneficiaries.1 

This announcement will have an important impact for many immigrant families. Due to restrictions on the basis of immigration status, full scope Medicaid coverage in the State of Michigan is not an option for many otherwise eligible immigrants. Non-citizens who do not qualify for full scope Medicaid may qualify for ESO Medicaid. ESO Medicaid provides a very limited benefit and MDHHS determines eligibility. This means that thousands of individuals are left without full medical coverage even in cases where a person’s health may be in serious jeopardy. In the state of Michigan, approximately 91,0000 immigrants are undocumented and do not qualify for full scope Medicaid.2 Additionally, there are many other lawfully present immigrants (e.g. foreign students, certain workers, individuals with Temporary Protected Status) who are ineligible for full scope Medicaid.

Under the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals are required to treat anyone with an emergency medical condition. In most states the emergency department is the only option for undocumented people with kidney failure who need dialysis treatment. Twelve other states have expanded their emergency Medicaid programs to cover outpatient dialysis services.3 Until these changes, undocumented immigrants needing dialysis were only treated at emergency departments when their life was threatened. These state Medicaid policy changes were desperately needed as undocumented immigrants with kidney failure have 14 times the mortality rate of individuals on scheduled dialysis.4

For the past few years, staff at the Michigan Immigrant Rights Center have been working with Jorge, who has End Stage Renal Disease and is in need of dialysis treatment.5 Until the recent change in coverage, most of Jorge’s dialysis services were not covered by ESO Medicaid. Without coverage, people like Jorge had to rely on emergency room dialysis, which is more invasive and less effective, or charity from providers or friends and family. With the new policy change, Jorge and others like him may seek ongoing dialysis services at facilities beyond emergency departments. This policy change will advance patients’ security and independence. It is estimated that the number of residents with ESRD whose immigration status makes them ineligible for Medicaid in Michigan may be in the range of 300-400 individuals.6 

We believe that every individual in Michigan, regardless of their immigration status or income, deserves full medical coverage and this policy change is a step forward. We are proud to have worked with great advocates across the state to make it possible for Michigan to join other states in covering dialysis treatment for patients like Jorge. 

The Michigan Elder Justice Initiative (MEJI), and student and faculty advocates from the University of Michigan Medical School joined MIRC in leading this advocacy. We urge those who support immigrant rights and health care access to join us in voicing support for this change by emailing comments to Mary Anne Sesti at the Michigan Department of Health and Human Services at SestiM@michigan.gov.
1 The ESO benefit does not include an organ transplant.
2 https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/MI
3 As of March 2019, Medicaid programs in Washington, California, Arizona, Colorado, Minnesota, Wisconsin, Illinois, North Carolina, Virginia, Pennsylvania, New York, Massachusetts and the District of Columbia provide reimbursement for standard outpatient dialysis.
4 Cervantes, L., Tuot, D., Raghavan, R., Linas, S., Zoucha, J., Sweeney, L., Vangala, C., Hull, M., Camacho, M., Keniston, A., McCulloch, C. E., Grubbs, V., Kendrick, J., & Powe, N. R. (2018). Association of Emergency-Only vs Standard Hemodialysis With Mortality and Health Care Use Among Undocumented Immigrants With End-stage Renal Disease. JAMA Internal Medicine, 178(2), 188. https://doi.org/10.1001/jamainternmed.2017.7039
5 The name used in this story is a pseudonym.
6 A recent Clinical Nephrology publication estimates there are somewhere between 318-363 undocumented immigrants with ESRD in Indiana, a state with a similar population of undocumented immigrants as Michigan, and a policy of providing emergency-only hemodialysis. This estimate does not include documented noncitizens who lack immigration status eligible for full-scope Medicaid.
Michigan Immigrant Rights Center | michiganimmigrant.org