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UPDATED: JUNE 2010

701

OTHER ELIGIBILITY REQUIREMENTS

PRESUMPTIVE ELIGIBILITY

Policy: Presumptive eligibility is Medicaid coverage provided to certain applicants who reasonably appear to meet all of the criteria, financial and non-financial, pending the completion of the full eligibility determination.

References: SSL Sect. 364-i 4. (a)(e)

364-1

368-a

Dept. Reg. 360-3.7

Part 531

ADMs 08 OHIP/ADM-2

97 ADM-10

90 ADM-9

Interpretation: A/Rs can apply for Medicaid through the presumptive eligibility process if they meet one of the following certain conditions:

• a pregnant women who applies for Medicaid at an Article 28 Pre-natal Care Provider or other entity designated by the State Department of Health, who has been trained to perform presumptive eligibility and perform application assistance ;

• a child under the age of 19 who applies for Medicaid with a Qualified Entity (QE) that has a signed Memorandum of Understanding (MOU) with the State Department of Health, or

• a patient in an acute care hospital awaiting discharge but needing the type of medical care provided by a Certified Home Health Agency, Long Term Home Health Care Program, nursing facility or hospice.

The sections that follow discuss these forms of presumptive eligibility:

• Nursing facility, hospice or home health care services, • Children up to age 19 • Pregnant women.

MRG