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BEM 136 1 of 3 PRESUMPTIVE ELIGIBILITY BPB 2016-001 1-1-2016

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Presumptive Eligibility Medicaid Only Presumptive eligibility is temporary Medicaid eligibility as determined by a trained qualified entity. This allows individuals to receive needed health coverage and providers to receive payment for services provided before a full Medicaid determination is completed. Qualified entities include but are not limited to local health departments, hospitals, and tribal health facilities operated by the Indian Health Services. These entities are trained and authorized by the Michigan Department of Health and Human Services (MDHHS). To be considered a qualified entity, under the regulation at 42 CFR 435.1110(b) (1), the provider must agree to make presumptive eligibility determinations consistent with state policies and procedures. Application A streamlined application is used to determine eligibility. Information on the presumptive eligibility application will be self- attested, without the need for verification. The application consists of a few simple questions such as name, household size and estimated monthly income. Presumptive eligibility is determined based on gross income reported at the time of the application. Eligibility is determined for an individual whose application is filed online, by a trained qualified entity. Eligibility Groups The eligibility groups for which qualified entities determine eligibility presumptively are:  Pregnant Women  Infants and children under age 19  Parents and caretaker relatives  Adult Group age 19-64