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ACA/FAMILY MEDICAID 105-1 Presumptive Eligibility

Supersedes: FMA 105-1 (07/01/06) Reference: ARM 37.82.101, .701; 42 CFR 435.1101-3; .1110 Overview: Presumptive eligibility (PE) allows eligible individuals to immediately receive Medicaid coverage while a full Medicaid application is processed. PE must be determined by a qualified entity. Pregnant women are only eligible for ambulatory prenatal care during the presumptive period while all other presumptive populations are eligible for all Medicaid services. Pregnant women are allowed only one PE period per pregnancy, while other presumptive populations are allowed one PE period in a 12-month period (from the most recent PE effective date). PRESUMPTIVE POPULATIONS: 1. ACA HMK Plus (FMA 201-4 Healthy Montana Kids Plus) 2. ACA HMK (CMA 201-5 ACA Healthy Montana Kids (HMK)) 3. ACA Former Foster Care Children (FMA 201-6 Former Foster Care) 4. ACA Parent/Caretaker Relative (FMA 201-1 ACA Parent Caretaker Relative) 5. ACA Pregnant Woman (FMA 201-2 ACA Pregnancy) 6. MBCCTP – Breast and Cervical Cancer (FMA 201-9 Breast and Cervical Cancer) 7. ACA Adult Medicaid (FMA 201-8 ACA Adult Medicaid) 8. Plan First (FMA 201-14 Plan First Coverage) QUALIFIED ENTITIES: Only qualified entities (QE), who have received appropriate training and certification can make presumptive eligibility determinations. QEs must be registered Medicaid providers, and include, but are not limited to: 1. Migrant Health Centers; 2. Public Health Departments; 3. Community Health Centers; 4. State Perinatal Programs; 5. WIC;