BCCT Medicaid

Presumptive Eligibility Information

Presumptive Eligibility Policies

Affordable Care Act

Presumptive Eligibility (PE)

• Organization that approves PE determinations • Authorized by DHS • Only employees of PP can make PE determinations • May not delegate PE authority

• Individual authorized to determine Presumptive Eligibility

• Under the supervision and authority of a PP

Presumptive Provider

Qualified Entity

QE Responsibilities: Process the Application

• Date stamp upon receipt

• Enter ALL client-reported information into MPEP

• A signature is required on the application

QE Responsibilities: Inform the Applicant

Information on the application must be true Applications are forwarded to DHS Additional information and verifications may be

required Medicaid determination ends PE benefits

QE Responsibilities: Maintain Documentation

• Print Documents

• NOA given to the applicant

• Maintain Documentation

QE Responsibilities: Valid PE Application

• First, Middle Initial and Last Name • Full address

Street, PO Box, City, State, County, Zip Code • Resident of Iowa • Application Date • Gender • Date of Birth

QE Responsibilities: Valid PE Application (cont’d)

• Applying for PE? Type of PE • SSN if possible (not necessary) • Type of Cancer (breast or cervical) • Presumptive Eligibility in the last twelve months • Applying for ongoing • Signature and date signed

Presumptive Eligibility Rules

• Iowa Resident • US citizen or qualified alien • Applicant statements • PE in last twelve months • Ongoing determination • Coverage • Right to file an appeal of Eligibility Decision

PE Program Types

PE Program Types

Pregnant Women BCCT Children

Hospital (Adults & Children)

Iowa Health & Wellness

Plan Parents/

Caretakers

Former Foster Care (E-MIYA)

Signature Requirement

CIN Information: New Client Index Number

CIN Information: Existing Client Index Number

Sample: Notice of Action (NOA)

Mistake in MPEP and application submitted

Retroactive ongoing

Medicaid request

Unusual type of income – not listed in

MPEP Incorrect Birthdate

CIN created with wrong

SSN

Incorrect Income

Human Services (DHS) Contact Center

(855) 889-7985 Monday - Friday 7 am–6 pm

IMEMPEPSupport@dhs.state.ia.us

QE Support: PE Policy & MPEP Technical

QE Support: Access to Online PE Materials

https://dhs.iowa.gov/ime/providers/tools-trainings-and-services/medicaid-initiatives/pe

Applicant: Rights and Responsibilities

https://dhsservices.iowa.gov/apspssp/ssp.portal

PE Provider Application Process Flow

Summary: Application Information

• Application date must be accurate • All client-shared data must be entered into MPEP • Applicant information is self-attested • Completed applications cannot be recreated or edited • Incomplete (in progress) applications can be continued

Summary: Application Information (cont’d)

• Applications expire 5 days after start if not completed • Summary Pages, at each section end, can be edited • SSN is not required but if you have an accurate SSN

populate the field • The CIN is created after saving Tell Us More page

• Returning and saving may create another CIN • To avoid recreating a CIN, use chevrons to navigate

1. If eligible, Presumptive eligibility…

A. Begins on the Application Date entered into MPEP

B. Is not retroactive

C. May only be used for services at an Iowa Medicaid provider

2. Which of the following statements is true?

A. The determination of PE is based on applicant self-attested statements

B. Ongoing Medicaid is based on some verified information gathered by the DHS.

3. QE’s should advise applicants’ on the probability of receiving ongoing Medicaid benefits?

A. True

B. False

4. By State of Iowa requirements, QEs are to complete PE training prior to state approval for becoming a QE?

A. True

B. False

C. It depends on what type of PE they will be determining

5. It is important to enter as much applicant information into MPEP as possible because…

A. It slows the determination of ongoing Medicaid

B. It reduces the need for applicants to provide DHS with information at a later date

C. It helps ensure that the correct person is in the system with the accurate CIN (SID)

D. It increases the accuracy of the PE determination and the ongoing Medicaid determination

6. With the exception of BCCT and Pregnant Woman, how often may all other PE groups receive PE benefits?

A. Once in a 12 month period

B. Three times a year

C. As often as needed

7. QE’s are to submit PE applications…

A. As soon as possible

B. Within 3 working days

C. Within 1 month of application

D. With all applicant reported information