Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 18 - RELATIVE RESPONSIBILITY FOR MAGI-BASED PROGRAMS
Section 477-18-006 - HOSPITAL PRESUMPTIVE ELIGIBILITY

Universal Citation: 477 NE Admin Rules and Regs ch 18 ยง 006

Current through September 17, 2024

The Department shall provide Medicaid during a presumptive eligibility period to individuals who are determined eligible by a qualified hospital. The determination is on the basis of preliminary information, that the individual has gross income at or below the income standard established for the applicable group, has attested to being a citizen or national of the United States or is in satisfactory immigration status, and is a resident of Nebraska, to be presumptively eligible in accordance with the policies and procedures established by the Department. Determinations are limited to:

1. Children (see 477 NAC 18-003);

2. Pregnant women (see 477 NAC 18-001.02);

3. Breast and Cervical Cancer (see Women's Cancer Program at 477 NAC 24-004);

4. Parents and caretaker relatives (see 477 NAC 18-002); and

5. Former foster care children (see 477 NAC 24-006).

A presumptive eligibility determination is limited to no more than one period within two calendar years per person.

A pregnant woman is eligible for ambulatory care only. The qualified provider may authorize a period of presumptive eligibility once per pregnancy.

Notice and fair hearing regulations do not apply to determinations of presumptive eligibility.

006.01 Qualified Entities Responsibilities

1. Notify the appropriate individual at the time a determination regarding presumptive eligibility is made, in writing or orally if appropriate, of such determination, that:
a. If a Medicaid application on behalf of the eligible individual is not filed by the last day of the following month, the individual's presumptive eligibility will end on that last day;

b. If a Medicaid application on behalf of the eligible individual is filed by the last day of the following month, the individual's presumptive eligibility will end on the day that a decision is made on the Medicaid application; and

c. If the individual is not determined presumptively eligible, the qualified entity shall notify the appropriate individual of the reason for the determination and that he or she may file an application for Medicaid with the Medicaid agency.

2. Provide the individual with an agency approved application for Nebraska Medicaid;

3. Within five working days after the date that the determination is made, notify the agency that the individual is presumptively eligible; and

4. Shall not delegate the authority to determine presumptive eligibility to another entity.

006.02 Qualified Hospital Criteria

1. Participate as a Medicaid provider;

2. Notify the Department of its decision to make presumptive determinations;

3. Agree to make determinations consistent with state policy and procedures;

4. Assist individuals in completing and submitting full applications;

5. Assist individuals in understanding required documentation requirements; and

6. Shall not be disqualified by the Department.

Disclaimer: These regulations may not be the most recent version. Nebraska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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