Medical Costs Incurred During Transit

Policy Letter 19-05

Publication Date: March 5, 2019

March 5, 2019

This Policy Letter outlines when and how Refugee Medical Assistance (RMA) will cover emergency medical costs of refugees and Special Immigrant Visa (SIV) holders during their transit from their port of entry to their final destination in the United States. State Refugee Coordinators and Refugee Health Coordinators (SRCs/RHCs) should collaborate with local resettlement agencies (1) to determine the costs of any medical procedure incurred during transit, (2) to determine whether a state Medicaid program can cover the costs, and (3) if state Medicaid cannot cover the costs, seek RMA reimbursement.

As refugees and SIVs make their journey to the United States, their port of entry may be in a different state than their final destination. Unfortunately, some refugees and SIV holders may require emergency medical assistance in the United States prior to arriving in their destination state. These circumstances create a number of issues among the resettlement network regarding:

  • Appropriate points of contact at the national, state, and local level;
  • Timely communication flow between states; and
  • Payment of outstanding bills.

These issues may result in unpaid medical bills being sent to collection agencies, which could impact refugees, SIV holders or their families’ successful long-term resettlement.

Notification and Workflow Guidance
In this Policy Letter, “destination state” refers to the state of final destination as allocated and assured through the U.S. Refugee Admissions Program. The “transit state” is the state where the refugee or SIV holder incurred medical costs. SRCs/RHCs in the destination and transit states should be coordinating and conducting notifications and follow-up actions as soon as possible to resolve any billing issues.

The SRC/RHC from the destination state may learn of the medical emergency from the local resettlement agency or from the refugee or SIV holder when they reach the destination state. Upon notification that the refugee or SIV holder incurred medical costs in transit, the SRC/RHC in the destination state should request, from the local resettlement agency, any necessary information regarding the case to ensure timely follow-up. This may include information on the refugee’s or SIV holder’s age, family composition, and documents related to the incident, including all medical bills.

The Use of RMA Funding
The SRC/RHC in the destination state should work with the SRC/RHC in the transit state to determine if the medical claim can be covered by Medicaid in either state and ensure that claims are paid as applicable. This will require each SRC/RHC to reach out to their respective state Medicaid programs regarding eligibility, including any nonfinancial requirements.

If Medicaid cannot cover the costs of medical care in transit, the SRC/RHC in the destination state should determine if the refugee or SIV holder is eligible for RMA. Pursuant to ORR regulations at 45 CFR 400.100(a)(1), a refugee or SIV holder, who otherwise meets the RMA requirements, is eligible for RMA if they are ineligible for Medicaid. If the refugee or SIV holder is not eligible for RMA, the SRC/RHC in the destination state should contact ORR for further consultation.

If you have any questions about the information in this Policy Letter, please do not hesitate to contact See Yang at

Jonathan H. Hayes
Acting Director
Office of Refugee Resettlement

Last Reviewed Date: