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MRG

UPDATED: JUNE 2010

711

OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY

CHILDREN UNDER THE AGE OF 19

$100 from child support received (See INCOME ADC, LIF, AND S/CC- RELATED DISREGARDS); and health insurance premiums (See INCOME ADC, LIF, S/CC AND SSI-RELATED BUDGETING METHODOLOGY HEALTH INSURANCE PREMIUM), if not already deducted from the wages. Do not count grants, loans, or student wages or grants of Temporary Assistance (TA) and Supplemental Social Security Income (SSI). All resources are disregarded.

When the child under age 19’s family income is equal to or less than the appropriate federal poverty level, s/he is presumptively eligible for all Medicaid covered care and services.

The qualified entity who has a signed MOU with SDOH:

• completes a personal screening interview with the A/R using the DOH-4441, “Medicaid Presumptive Eligibility for Children Screening Form”; • contacts the designated toll-free number to determine whether the screened eligible child is entitled to PE (NOTE: a child is entitled to only ONE period of PE in a 12 month period); • provides the applying household a determination letter on the approved form, “Presumptive Eligibility for Children Screening Determination Letter”, OHIP-0012 indicating their findings, and advises the applying household of the next steps in the process, which includes mandatory completion of a full application for Medicaid (DOH 4220, ACCESS NY Application) if eligible for PE, and/or referrals to the LDSS, or to a Facilitated Enroller if ineligible for PE. • informs the applicant/representative of his/her rights and responsibilities as well as issuing required informational materials and brochures; • assists the PE eligible applicant/representative with the “Access NY Health Care Application”, DOH-4220 which must be completed, signed and properly documented in order for the LDSS to determine ongoing Medicaid eligibility. Responsibilities including requesting and compiling necessary documentation are delegated to the QE;

NOTE: QE’s may enter into formal agreements with Facilitated Enrollers (FEs) to assist them in the Medicaid application,