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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 20, 2023

Page 1 of H-3200 Replacing September 6, 2016 Revised/added text indicated by underscore Deleted text indicated by “**”

H-3200 HOSPITAL PRESUMPTIVE ELIGIBILITY

H-3210 GENERAL INFORMATION

The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act, or ACA) include provisions enabling states to improve and expand access to health insurance coverage for the Medicaid and CHIP populations. One such provision is the option for qualified hospitals to be designated as entities qualified to make presumptive Medicaid eligibility determinations based on preliminary, self-attested information obtained from individuals seeking medical assistance.

Effective January 1, 2014, any hospital designated by Louisiana Medicaid as a Hospital Presumptive Eligibility Qualified Entity (HPEQE) may obtain information and determine Hospital Presumptive Eligibility (HPE) for individuals who are not currently enrolled in Medicaid and who are in need of medical services covered under the State Plan.

Household composition and countable income for HPE coverage groups are determined using a simplified Modified Adjusted Gross Income (MAGI) methodology. Refer to I-1550 MAGI Determinations. There is no resource test for these groups.

H-3220 COVERAGE GROUPS

HPE coverage groups include the following individuals: • Adults; • Certain individuals needing treatment for breast and/or cervical cancer (BCC); • Children under age 19; • Former foster care children; • Parents and caretaker relatives; • Pregnant women; and • Take Charge Plus.

Note: Individuals must meet all of the requirements of the Medicaid program for which they are determined presumptively eligible. For example, a pregnant woman must be a citizen or a qualified alien to qualify for HPE.