Presumptive Eligibility For Children And Adults

Presumptive eligibility determination for qualifying medical coverage groups can only be provided by a qualified hospital defined in Section 011 of these rules. (7-1-24) 01. Presumptive Eligibility Decisions. Decisions of presumptive eligibility can be made for individuals who meet program requirements for MAGI-based Medicaid coverage. (7-1-24) 02. Presumptive Eligibility Determination. Presumptive eligibility determinations are made by a qualified hospital when an individual receiving medical services is not covered by health care insurance and the financial assessment by hospital staff indicates the individual is eligible for Medicaid coverage in Idaho. This determination is made by hospital staff through an online presumptive application process: (7-1-24) a. Prior to completion of a full Medicaid application; and (7-1-24) b. Prior to a determination being made by the Department on the full application. (7-1-24) 03. Presumptive Eligibility Period. The presumptive eligibility period begins on the date the presumptive application is filed online and ends with the earlier of the following: (7-1-24) a. The date the full eligibility determination is completed by the Department; or (7-1-24) IDAHO ADMINISTRATIVE CODE IDAPA 16.03.01 – Eligibility for Health Care Department of Health and Welfare Assistance for Families & Children Section 546 Page 18 b. The end of the month after the month the qualified hospital completed the presumptive eligibility determination. (7-1-24)