Current through Register Vol. 50, No. 9, September 20, 2024
A. Effective December 31, 2013 any hospital
designated by Louisiana Medicaid as a hospital presumptive eligibility
qualified provider (HPEQP) may obtain information and determine hospital
presumptive eligibility (HPE) for individuals who are not currently enrolled in
Medicaid and who are in need of medical services covered under the state plan.
1. Coverage groups eligible to be considered
for hospital presumptive eligibility include:
a. parents and caretaker relatives;
b. pregnant women;
c. children under age 19;
d. former foster care children;
e. family planning; and
f. certain individuals needing treatment for
breast or cervical cancer.
B. Qualified Hospitals. Qualified hospitals
shall be designated by the department as entities qualified to make presumptive
Medicaid eligibility determinations based on preliminary, self-attested
information obtained from individuals seeking medical assistance.
1. A qualified hospital shall:
a. be enrolled as a Louisiana Medicaid
provider under the Medicaid state plan or a Medicaid 1115
demonstration;
b. not be suspended
or excluded from participating in the Medicaid Program;
c. have submitted a statement of interest in
making presumptive eligibility determinations to the department; and
d. agree to make presumptive eligibility
determinations consistent with the state policies and procedures.
C. The qualified
hospital shall educate the individuals on the need to complete an application
for full Medicaid and shall assist individuals with:
1. completing and submitting the full
Medicaid application; and
2.
understanding any document requirements as part of the full Medicaid
application process.
D.
Eligibility Determinations
1. Household
composition and countable income for HPE coverage groups are based on modified
adjusted gross income (MAGI) methodology.
2. The presumptive eligibility period shall
begin on the date the presumptive eligibility determination is made by the
qualified provider.
3. The end of
the presumptive eligibility period is the earlier of:
a. the date the eligibility determination for
regular Medicaid is made, if an application for regular Medicaid is filed by
the last day of the month following the month in which the determination for
presumptive eligibility is made; or
b. the last day of the month following the
month in which the determination of presumptive eligibility is made, if no
application for regular Medicaid is filed by that date.
4. Those determined eligible for presumptive
eligibility shall be limited to no more than one period of eligibility in a
12-month period, starting with the effective date of the initial presumptive
eligibility period.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
