601.04 Application Process

The PE process will be initiated when an applicant in an authorized hospital attests to being eligible for Medicaid. The hospital will use their own offline methods to determine whether they will grant the individual presumptive eligibility for Medicaid. If the hospital decides to determine the individual presumptively eligible for Medicaid, they will complete a DHHS Form 3402, the Medicaid Presumptive Eligibility Application, which is a modified version of DHHS Form 3400, the Healthy Connections Application. This modified version will contain fewer questions than DHHS Form 3400. If the hospital determines the individual presumptively eligible, the hospital employee must assist the applicant with completing a full application.

Regardless of whether a full application is completed, DHHS Form 3402 will be submitted to a subset of eligibility workers tasked with completing presumptive eligibility determinations. When the application is received by the eligibility worker, they will enter the information into Cúram and use the Manual Eligibility Process to force eligibility for two months. It will be assumed that all PE applicants will be eligible for benefits. The worker processing the application should not attempt to perform any verifications and should always complete a positive eligibility determination. If an authorized representative signs the PE application for applicant, the authorized representative will also need to complete Form 1282.

PE Application ProcessPE Application Process