Page 287

MRG

UPDATED: JUNE 2010

713

OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY

CHILDREN UNDER THE AGE OF 19

• open and maintain Medicaid case (s) including all undercare and renewals for individuals found eligible for ongoing coverage for a period of no less than 12 months from the date of screening/application. If the PE-only eligible child turns age 19 during the PE authorization period, authorizes the PE-only case to the last day of the month in which the child turns age19;

Disposition: Parents/guardians of children up to age 19 may attest to basic information including citizenship, identity, residency, household size and composition and income during a brief interview with a Qualified Entity. The QE may provide services under Medicaid presumptive eligibility when the screened child’s estimated family income (after applying simple disregards), does not exceed the applicable income standards. The PE eligible child may receive all care, services and supplies covered by the Medicaid program, from any Medicaid enrolled provider, prior to a full Medicaid determination by the LDSS. A CBIC card will not be issued for the PE period. Cards will be issued only for fully eligible MA children.

Children screened eligible for PE may receive ONE presumptive coverage authorization period in a 12-month period. Children found fully eligible will be authorized for no less than 12 months of Medicaid coverage OR through the last day of the month in which their 19th birthday occurs, whichever is earlier.

A completed MA application, DOH 4220, must be submitted by the QE along with the PE screening form and supporting documentation.