Page 284
MRG
UPDATED: JUNE 2010
710
OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY
CHILDREN UNDER THE AGE OF 19
Policy: Presumptive eligibility is a means of immediately providing Medicaid covered care and services to children under the age of 19. A Qualified Entity (QE) performs a preliminary assessment of the child’s eligibility based upon guidelines established by the Department. If the child is found to be presumptively eligible for Medicaid s/he is provided full Medicaid care and services for a limited period of time during which a full determination of eligibility is performed.
References: SSL Sect. 364-i4. (a)-(e)
ADM
08 OHIP/ADM-2
Interpretation: A child under the age of 19 is presumed eligible for full Medicaid coverage when a Qualified Entity determines that the child’s household income does not exceed the appropriate federal poverty level (133% for children ages 1-5; 100% for children ages 6-18; and 200% for children under the age of 1).
The information used in the presumptive eligibility determination may be attested to and does not have to be verified in order to authorize presumptive coverage.
The household size is determined by counting the child and the mother of the applying child, and, if she is pregnant, count as 2 (mother plus the unborn child). Count the legal spouse and/or father of the child, if they live in the household. Count as 1 the Caretaker Relative (if no parents live in the household) and if the Caretaker Relative will also be applying for Medicaid. Count all of the children under age 21 in the household whether or not they are applying. Do not count persons who receive Temporary Cash Assistance or SSI cash assistance.
The following deductions from monthly gross income of the household (including the income of the caretaker relative, if they are part of the household count and are applying for Medicaid) are allowed: $90 from earned income (See INCOME ADC, LIF, AND S/CC-RELATED BUDGETING METHODOLOGY $90 WORK EXPENSE DISREGARD); child care from employment income (See INCOME ADC, LIF, AND S/CC-RELATED BUDGETING METHODOLOGY CHILD/INCAPACITATED ADULT CARE COST);