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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 April 2022 Subchapter Subject Page ending with Page M0120 MEDICAL ASSISTANCE APPLICATION M0120.500 16

C. Hospital Presumptive Eligibility The Affordable Care Act required states to allow approved hospitals to enroll patients who meet certain Families & Children covered groups in Medicaid for a limited time on the basis of their presumptive eligibility. The Department of Medical Assistance Services (DMAS) is responsible for coordinating the HPE Agreement with approved hospitals, providing training and technical assistance, and monitoring the appropriate use of the HPE enrollments. HPE is not available to individuals who are already actively enrolled in Medicaid or FAMIS. Local eligibility staff do not determine eligibility for HPE. 1. HPE Determination and Enrollment To provide an individual HPE coverage, the hospital staff obtains basic demographic information about the individual, as well as the attestations from the individual regarding Virginia residency (including locality), U.S. citizenship or lawful presence, Social Security number, household size and income, and requirements related to a covered group. As the information is self attested, no verifications or additional proof is required. Hospital staff determines eligibility and enters the approved individual’s data into the HPE webpage located in the provider portal in the Medicaid Enterprise System (MES—formerly the Medicaid Management Information System [MMIS]). This information is electronically transferred to the Cover Virginia Central Processing Unit (CPU) which is responsible for enrolling the individual in the appropriate aid category (AC) in MMIS. The HPE enrollment is not entered in the Virginia Case Management System (VaCMS). HPE recipients are not entered into a managed care organization (MCO). The hospital is responsible for providing immediate notification to the individual of his HPE coverage. They will request that he file a full MA application by the end of the following month so that continued eligibility for Medicaid can be evaluated without an interruption in coverage. The HPE covered groups and the ACs are: • Pregnant Women (AC 035) • Child Under Age 19 (AC 064) • Low Income Families with Children (LIFC) (AC 065) • Former Foster Care Children Under Age 26 (AC 077) • Breast & Cervical Cancer Prevention & Treatment Act (BCCPTA) (AC 067) • Plan First (AC 084) • MAGI Adults (AC 106) ( effective January 1, 2019) Individuals enrolled on the basis of HPE receive a closed period of coverage beginning with the date of the HPE determination through the last day of the following month or the date MA eligibility is determined, whichever comes first. Enrollment in HPE is not based on the date of the hospital admission nor the first day of the month. While enrolled as HPE, individuals in the Child Under Age 19 years, LIFC, Former Foster Care Children Under Age 26, BCCPTA, and MAGI Adults covered groups receive full Medicaid benefits. HPE pregnant women coverage