Hospital Presumptive Eligibility (HPE) Periods 510-03-60-30

(New 5/1/2017 ML #3498)

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HPE begins on the day the HPE eligibility determination is made and does not begin retroactive to the first of the month of the HPE Application. If determined eligible, the individual will remain eligible through the month following the month the HPE eligibility determination was made.

Example : Jane applies for and is found eligible for HPE coverage on January 10th. Jane’s HPE eligibility period will be authorized for January 10th through February 28th.

When an application for ongoing Medicaid coverage has not been submitted, HPE ends on the last day of the month following the month the HPE eligibility determination is made.

Example : Tyler applies for and is found eligible for HPE coverage on January 25th. His HPE eligibility period is authorized for January 25th through February 28th.

When an application for ongoing Medicaid coverage has been submitted, HPE ends on the date a full determination is made. If the individual requested eligibility for any of the THMP months based on the full application, eligibility must be determined for each month requested. In addition, if more time is needed to make a full determination of eligibility, the Eligibility Worker must grant a month by month extension of HPE coverage until the full determination is made.

If eligible, the individual’s eligibility may change from HPE to Traditional or Expansion Medicaid coverage.

If not eligible, the individual’s eligibility will remain unchanged.

Example #1 : Sophie applies for and is found eligible for HPE coverage on January 25th. Her HPE eligibility period is authorized for January 25th through February 28th.

On February 15th, an application is received at the county and a full determination is made. The determination results in Sophie being determined eligible for Medicaid for the application month and ongoing. In addition, Sophie requested and was found eligible for the THMP month of January.

For February and ongoing, Sophie’s eligibility will change from HPE to Traditional Medicaid.

For January, Sophie’s eligibility will change from HPE to Traditional Medicaid.

Example#2 : Mary applied for and was approved for HPE coverage on January 19th. Her HPE eligibility period was authorized for January 19th through February 28th.

On February 25th, a full application is received. The eligibility for the full application cannot be made in February as additional information is needed. Therefore, the worker must authorize an additional month of HPE eligibility. Thus the HPE eligibility end date changes from February 28th to March 31st.

On March 18th, the worker receives all of the information needed to make a full determination.

If eligible, Mary’s eligibility for March will change from HPE to Traditional Medicaid.

If not eligible, Mary’s HPE eligibility must end on March 18th.

Individuals are only eligible for one (1) period of HPE period per calendar year with the exception of an individual who is pregnant. Pregnant Women can receive HPE coverage once per pregnancy.