UPM P-1523.10 - Determining Eligibility for Presumptive Eligibility for Children

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-1-05 Transmittal: UP-06-03 P-1523.10 ______________________________________________________________________________ Section: Type: The Eligibility Process PROCEDURES ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Children FMA _______________________________________________________________ Subject: Determining Eligibility for Presumptive Eligibility for Children ______________________________________________________________________________

P-1523.10 Qualified Entity Responsibilities

1. A Qualified Entity (QE) will accept applications and grant Presumptive Eligibility (PE) whenever they have contact with a child under the age of nineteen whose family income is under 185% of the Federal Poverty Level and who is in need of medical care.

The QE will either utilize the Automated Eligibility Verification System (AEVS) or contact the DSS Regional Processing Unit (RPU) to determine if the child to be granted PE is currently enrolled in the HUSKY A program.

The QE will secure a fully completed and signed W-1HUS – “HUSKY Application and Renewal Form” from the parent or caretaker relative of the child. The child may also apply if living independently or if she or he is familiar enough with the family’s circumstances to accurately complete the application.

The QE will submit any available verification of HUSKY eligibility requirements (proof of income, residency, alien status) along with the fully completed and signed W-1HUS at the time of application to the DSS RPU.

If at the time of the presumptive eligibility determination there are missing verifications the QE is responsible for giving the applicant a checklist on the form prescribed by the Department requesting that the missing information be provided to the Department within ten (10) days along with a postage paid return envelope to the appropriate DSS RPU (envelope to be provided by the Department).

The QE will review and consider all factors of eligibility utilized by DSS as verified by the statements made by the applicant or recipient on the application form along with any available verification.

The QE will grant presumptive eligibility to the child no later than the close of business of the next working day if eligibility requirements are met.

The QE will refer the applicant to ACS for possible eligibility in the HUSKY B program if eligibility requirements have not been met because the family’s income exceeds the HUSKY A income guideline limit.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-1-05 Transmittal: UP-06-03 P-1523.10 Page 2 ______________________________________________________________________________ Section: Type: The Eligibility Process PROCEDURES ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Children FMA _______________________________________________________________ Subject: Determining Eligibility for Presumptive Eligibility for Children ______________________________________________________________________________

P-1523.10 Qualified Entity Responsibilities (continued)

9. The QE will provide the child (and/or the guardian) with a completed form W-538 Medicaid Presumptive Eligibility Certification and Guarantee of Payment so that medical services can be obtained upon granting PE.

10. The QE will transmit via fax, to the appropriate DSS RPU, copies of the W- 538, the completed and signed W-1HUS form, any available verifications and the verification checklist used for the determination of presumptive eligibility.

The QE will serve as agents of DSS and agree to abide all DSS policies and procedures, including but not limited to, the areas of confidentiality, equal treatment, and nondiscrimination.

The QE will maintain the W-538 in a secure location and maintain a log of the issuance of the W-538.

The QE will designate liaisons to the Department.

Department of Social Services Responsibilities

The Department of Social Services (DSS) shall, as the state agency responsible for the administration of the HUSKY A program and the designation of organizations as QE’s:

Ensure that the DSS RPU’s, upon their receipt of the QE transmission described in 10. above immediately grant presumptive eligibility for the HUSKY A program on the DSS Eligibility Management System (EMS) so that the child can immediately access medical services.

Issue a DSS Medicaid CONNECT card for the eligible child.

Notify the QE of the presumptive eligibility grant.

Process the W-1HUS “HUSKY Application and Renewal Form” for a final determination of HUSKY A eligibility utilizing the regular application process.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-1-05 Transmittal: UP-06-03 P-1523.10 Page 3 ______________________________________________________________________________ Section: Type: The Eligibility Process PROCEDURES ______________________________________________________________________________ Chapter: Program: Presumptive Eligibility for Children FMA _______________________________________________________________ Subject: Determining Eligibility for Presumptive Eligibility for Children ______________________________________________________________________________

P-1523.10 Department of Social Services Responsibilities (continued)

Refer the W-1HUS “HUSKY Application and Renewal Form” to ACS for a determination of HUSKY B eligibility, if the family’s income is determined to be greater than the HUSKY A income guideline limit.

Designate liaisons to the QE for each of the DSS RPU’s.

Notify the QE of any changes thereto and shall allow the QE a reasonable period of time, not to exceed five (5) business days, to comply with such changes.