Medical Assistance Programs -
K.  CAWEM


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  Release 70:  Effective July 1, 2013

The Citizen/Alien-Waived Emergent Medical (CAWEM) program is available to individuals who meet all the nonfinancial and financial eligibility requirements for a medical assistance program except for citizen/alien status and Social Security number requirements. Individuals eligible for CAWEM are only eligible for emergency medical benefits, including childbirth (labor and delivery) services.

Exception: There is no CAWEM eligibility under the OHP-CHP or HKC category.

The worker does not need to make a decision about whether the person is in need of emergency medical treatment or childbirth services. Medical decisions are determined by the person's medical provider pursuant to the administrative rules of the Office of Medical Assistance Programs. If a medical provider has questions about whether a condition is covered, they should contact the Division of Medical Assistance Programs (DMAP) at 800-336-6016.

CAWEM medical assistance is authorized under the program (BCCTP, MAA, MAF, EXT, OHP, OSIPM and SAC) for which the person would qualify if they met the citizen/alien requirement. When benefits are established, CAWEM clients receive a medical coverage letter stating:

"COVERAGE IS LIMITED TO EMERGENCY MEDICAL SERVICES. LABOR AND DELIVERY SERVICES FOR PREGNANT WOMEN ARE CONSIDERED AN EMERGENCY."

A child born to a CAWEM mother is an assumed eligible newborn (AEN). Add the child's medical eligibility to the case using the AEN N/R code.

Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070
OHP-OPU; Effective Dates for the Program: 461-135-1102

Most noncitizen children who have legal immigration status but who do not meet the financial eligibility requirements of a Medicaid or CHIP program are eligible for HKC if their family income is at or below 301 percent FPL. (Refer to Noncitizens Worker Guide #1: Noncitizen Charts (NC-WG#1).

Noncitizen children without legal immigration status are not eligible for CHIP or HKC.

Pre-Natal Expansion Program

The CAWEM Pre-Natal Expansion (CWX) Program provides medical services for pregnant CAWEM clients who reside in one of the participating counties. Currently, there are 15 counties participating in the CWX program including: Benton, Clackamas, Columbia, Crook, Deschutes, Douglas, Hood River, Jackson, Jefferson, Lane, Morrow, Multnomah, Union, Wasco and Umatilla counties.

This program was first implemented April 1, 2008, in Multnomah and Deschutes counties.

The program expanded to Benton, Clackamas, Hood River, Jackson and Lincoln counties effective October 1, 2009. Lincoln County ended their participation in the program effective December 4, 2009.

This program then expanded to Lane County effective January 1, 2011.

As of July 1, 2011, Columbia, Crook, Douglas, Jefferson, Morrow, Union, and Wasco counties were added to the program.

The program then expanded to Umatilla County, effective April 1, 2012.

The program uses OHP-CHP funding to pay for prenatal care. OHP-CHP funds are permitted for the program because the medical services are limited to prenatal services and benefit the unborn child, who will be a U.S. citizen at birth:

Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070


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