Service Furnished to Undocumented Aliens

Novitas Solutions (formerly Highmark Medicare Services) is the Administrative Contractor for the Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract.

Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens, provides $250 million per year for fiscal years (FY) 2005-2008 for payments to eligible providers for emergency health services provided to undocumented aliens and other specified aliens. Two-thirds of the funds will be divided among all 50 states and the District of Columbia based on their relative percentages of undocumented aliens. One-third will be divided among the six states with the largest number of undocumented alien apprehensions.

From the respective state allotments, payments will be made directly to hospitals, certain physicians, and ambulance providers for some or all of the costs of providing emergency health care required under Section 1867 and related hospital inpatient, outpatient and ambulance services to eligible individuals. Eligible providers may include an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization. A Medicare critical access hospital (CAH) is also a hospital under the statutory definition. Payments under Section 1011 may only be made to the extent that care was not otherwise reimbursed (through insurance or otherwise) for such services during that fiscal year.

Payments may be made for services furnished to certain individuals described in the statute as: 

1. Undocumented aliens;
2. Aliens who have been paroled into the United States at a United States port of entry for the purpose of receiving eligible services; and 
3. Mexican citizens permitted to enter the United States for not more than 72 hours under the authority of a biometric machine readable border crossing identification card (also referred to as a "laser visa") issued in accordance with the requirements of regulations prescribed under a specific section of the Immigration and Nationality Act.

Section 1011 Program Update

The Centers for Medicare & Medicaid Services (CMS) has announced the sunsetting of the Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens Program at the end of fiscal year 2016. Providers actively billing Section 1011 were notified on December 28, 2015.  Please see the Q&A document in the Downloads section below for answers to questions you may have.

For CMS Section 1011 correspondence write to:

Centers for Medicare & Medicaid Services

Program 1011

PO Box 8040

Baltimore, Maryland 21244-9040