MICHIGAN DEPARTMENT OF COMMUNITY HEALTH

NOTICE OF PROPOSED POLICY

Public Act 280 of 1939, as amended, and consultation guidelines for Medicaid policy provide an opportunity to review proposed changes in Medicaid policies and procedures. Please review the policy summary and the attached materials that describe the specific changes being proposed. Let us know why you support the change or oppose the change. Submit your comments to the analyst by the due date specified. Your comments must be received by the due date to be considered for the final policy bulletin. Thank you for participating in the consultation process.

Director, Program Policy Division Bureau of Medicaid Policy and Health System Innovation
Project Number: Comments Due: Proposed Effective Date:

1411-PE

May 8, 2014

July 1, 2014

Mail Comments to:

Eligibility Policy Bureau of Medicaid Policy and Health System Innovation Medical Services Administration P.O. Box 30479 Lansing, Michigan 48909-7979 Fax Number: (517) 241-8969

Telephone Number: (517) 335-5107 E-mail Address: eligibilitypolicy@michigan.gov Policy Subject: Presumptive Eligibility Affected Programs: Medicaid, Healthy Michigan Plan

Distribution: Modified Adjusted Gross Income (MAGI) Manual Holders Policy Summary: This policy describes the presumptive eligibility periods and eligibility groups or populations for which qualified entities may determine Medicaid eligibility presumptively. Purpose: Qualified entities have been expanded to include hospitals; previously Local Health Departments and Tribal Health Centers participated in determining eligibility presumptively.

Public Comment Cover (07/11)

Michigan Department of Community Health Medical Services Administration

Distribution: Issued: Subject: Effective: Programs Affected: Modified Adjusted Gross Income (MAGI) Manual Holders May 15, 2014 (Proposed) Presumptive Eligibility July 1, 2014 (Proposed) Medicaid, Healthy Michigan Plan

The Patient Protection and Affordable Care Act authorizes states to implement a presumptive eligibility period for select eligibility groups or populations. This will assist individuals who need health coverage and allow healthcare providers to receive payment for services provided before a full Medicaid determination is completed. Presumptive eligibility is determined based on gross income reported at the time of the application. Presumptive eligibility will be determined for an individual whose application is filed online, by a trained qualified entity. The eligibility groups or populations for which qualified entities determine eligibility presumptively are: Pregnant Women Infants and Children under age 19 Parents and Caretaker Relatives Adult Group age 19-64 Former Foster Care Children Certain individuals needing treatment for breast or cervical cancer

Presumptive eligibility benefits for infants, children and adults are the same as those provided under the Medicaid category for which the individual is determined to be presumptively eligible. Coverage for a pregnant woman is limited to ambulatory prenatal care services only. Covered services include physician visits for prenatal care, prescription drugs related to pregnancy and prenatal laboratory tests. The presumptive eligibility period begins on the date the determination is made by the qualified entity. The end date of the presumptive period is the earlier of: The date the eligibility determination for regular Medicaid is made, if an application for Medicaid is filed by the last day of the month following the month in which the determination of presumptive eligibility is made; or The last day of the month following the month in which the determination of presumptive eligibility is made, if no application for Medicaid is filed by that date.

The beneficiary must complete a Medicaid application and receive a Medicaid determination to avoid losing coverage when the temporary eligibility period ends. This must be completed within 60 days of the date of the presumptive eligibility determination. Presumptive eligibility is limited to one period of eligibility during any consecutive 12 month period. Pregnant women are limited to one presumptive eligibility period per pregnancy.

Proposed Policy Draft Page 2 of 2

A streamlined electronic application is used by the qualified entity to determine presumptive eligibility. Information on the presumptive application will be self-attested, without the need for verification. The application consists of a few simple questions such as name, household size and estimated monthly income. Qualified entities include but are not limited to local health departments, hospitals, and tribal health facilities operated by Indian Health Services trained and authorized by the Michigan Department of Community Health (MDCH) to process applications. To be considered a qualified entity, under the regulation at 42 CFR 435.1110(b) (1), the provider must agree to make presumptive eligibility determinations consistent with state policies and procedures. Providers interested in becoming a qualified entity may send an email to laurthelhayes@maximus.com to register for a training session.