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June 2021

F04 (Pre-MAGI)—EMS F04 (Pre-MAGI)—Code not used in ImpaCT

2540.09 HUSKY A Extended Medical Assistance

Discontinued from F07 due to new or increased income from child support • TFA terminated because of collection of child support under Title IV-D • Sprouts from F07 (as long as they had received one month of F07) No income or asset test 12 months (1st month begins with the month following F07 ineligibility)

Or if no longer child < 19 in the home SEE DURATION RULES ABOVE. F04 rules are same as F03

*** F04 is replaced by X04

F06--EMS F06C (Children)—ImpaCT

F06—EMS F06P (Pregnant)—ImpaCT

1523.05 HUSKY A Presumptive Eligibility (PE for Children and Pregnant Women)

This coverage group was re-opened 7/1/05

W-1PE (application) and W-538 (PE voucher) are needed with each PE submission

This program is for HUSKY children (under 19) and pregnant women. It allows “Medicaid Certified Entities” (Qualified Entities) to temporarily grant Medicaid to children or pregnant women 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

W-538 (Paper voucher) given to client is good for 10 calendar days.

PE coverage period - In most cases, lasts until end of second month

If voucher is given to ineligible client, then PE may end earlier.

ImpaCT will automatically close PE coverage at the end of the second month if client is not found eligible for Medicaid

PE eligibility for pregnant women is only allowable once per pregnancy

PE eligibility for children allowed two times per calendar year