170 PRESUMPTIVE ELIGIBILITY

170.1 A pregnant woman or a child under the age of 19 may apply for presumptive eligibility for immediate temporary medical services through designated presumptive eligibility sites or a qualified hospital presumptive eligibility site that provides presumptive eligibility determinations. A. To qualify for presumptive eligibility, a child under the age of 19 shall have a declared household income that shall be greater than 142% but not exceed 260% of Federal Poverty Level; or B. To qualify for presumptive eligibility, a pregnant woman shall have an attested pregnancy, declare that her household's income shall be greater than 195% but not exceed 260% of the Federal Poverty Level; and C. The applicant must be a United States citizen or a lawfully residing immigrant as defined in Section 110 or meet the exceptions outlined in 110.1.C.3.a. 170.2 Presumptive eligibility sites and qualified hospital presumptive eligibility sites must be certified by the Department of Health Care Policy and Financing to make presumptive eligibility determinations. Presumptive eligibility sites and qualified hospital presumptive eligibility sites must be re-certified by the Department of Health Care Policy and Financing every year to remain approved as presumptive eligibility sites. A. The presumptive eligibility site or qualified hospital presumptive eligibility site shall forward the medical assistance application to the County Department of Human Services within five business days of the received date. 170.3 The presumptive eligibility period begins on the date the applicant(s) is determined eligible and ends with the day an eligibility determination for Medical Assistance is made for the applicant(s). 170.4 The County Department of Human Services or Medical Assistance site must make an eligibility determination within 45 days from the date of the medical assistance application. A. Medical Assistance applicants may appeal if a County Department of Human Services is unable to act within 45 days of the medical assistance application date or the denial of a medical assistance application. Appeal procedures are outlined in Section 600. B. A presumptively eligible member may not appeal the end of a presumptive eligibility period. 170.5 Applicants who already receive another medical assistance program cannot receive presumptive eligibility. 170.6. An applicant may only receive presumptive eligibility once every 12 months with the exception of pregnant women who may receive presumptive eligibility once every pregnancy.