Page 3

Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued June 20, 2023

Page 3 of H-3200 Replacing September 6, 2016 Revised/added text indicated by underscore Deleted text indicated by “**”

• Ends the last day of the month following the month in which the HPE determination is made if the beneficiary has not filed an application for regular Medicaid; • Continues until the eligibility determination is made if an application for regular Medicaid is received prior to the end of the HPE certification period; and • Is limited to no more than one HPE certification period every twelve (12) months for all eligibility groups, with the exception of pregnant women, who are limited to one certification period per pregnancy.

H-3240.3 HPE DECISION

If the HPE potential beneficiary is determined to be presumptively eligible the HPEQE is responsible for: • Advising the beneficiary, in writing, of their presumptive eligibility at the time the determination is made by providing a copy of the approved BHSF Form 1-HPE, Assessment Tool for Hospital Presumptive Eligibility Only; • Educating the beneficiary regarding HPE requirements and conveying the importance of submitting BHSF Form 1-A, Application for Health Coverage to Louisiana Medicaid prior to the end of the HPE certification period in order for benefits to continue; • Assisting in the completion and filing of the BHSF Form 1-A; and • Forwarding the completed HPE assessment within five (5) working days of the HPE determination, via fax, to (225) 389-2741 or (877) 747-0985. • The HPEQE is prohibited from requiring individuals to provide verification of any of the eligibility factors used in a Medicaid determination. The HPEQE must accept client attestation for all factors of eligibility.

If the individual is determined not to be presumptively eligible, the HPEQE is responsible for: • Assisting the individual with completing the BHSF Form 1-A; or • Advising the individual that they may apply for a formal determination of Medicaid eligibility by:  Seeking assistance from the in-hospital financial department;