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June 2021
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1902(a)(10)(A)(i)(VIII) 42 CFR 435.119
HUSKY D Hospital Presumptive Eligibility for Low Income Adults
• Adults age 19-64 • Not eligible for Medicare • US Citizens or Qualified Non-Citizens • W-1PE (application) and W-538 (Voucher) is needed with each PE submission
Allows contracted hospitals (“Medicaid Certified Entities”) to temporarily grant Medicaid to adults and then send the completed application form to RPU at DSS
The RPU (Regional Processing Unit) staff will grant PE coverage. The client and/or their CAC pursues ongoing medical coverage via AHCT
138% of the FPL (includes 5% disregard)
No applied income
No asset test
In most cases, lasts until end of second month. However, may last longer than 60 days if a full Medicaid application is pending while awaiting a Medicaid determination
W-538 (Paper voucher) given to client is good for 10 calendar days.
ImpaCT will automatically close PE coverage at the end of the second month if client is not found eligible for Medicaid
If voucher is given to ineligible client, then PE may end earlier.
PE eligibility allowed two times per calendar year
M11 (MAGI)—EMS M11 (MAGI)—ImpaCT
42 CFR 435.110 1902(a)(10)(A)(i)(I) 1931(b) and (d) HUSKY A Hospital Presumptive Eligibility (PE for Parents and Caretakers)
• HUSKY Parents and Caretakers only, child in the home <19 • Not pregnant • US Citizens or Qualified Non-Citizens • W-1PE (application) and W-538 (Voucher) is needed with each PE submission
Allows contracted hospitals (Medicaid Certified Entities) to temporarily grant Medicaid to adults and then send the completed application form to RPU at DSS
The RPU (Regional Processing Unit) staff will grant PE coverage. The client and/or their CAC pursues ongoing medical coverage via AHCT
In most cases, lasts until end of second month. However, may last longer than 60 days if a full Medicaid application is pending while awaiting a Medicaid determination
W-538 (Paper voucher) given to client is good for 10 calendar days.
ImpaCT will automatically close PE coverage at the end of the second month if client is not found eligible for Medicaid
If voucher is given to ineligible client, then PE may end earlier.
PE eligibility allowed two times per calendar year