42 CFR 435.1102 - Children covered under presumptive eligibility.
(a) The agency may elect to provide Medicaid services for children under age 19 or a younger age specified by the State during a presumptive eligibility period following a determination by a qualified entity, on the basis of preliminary information, that the individual has gross income (or, at state option, a reasonable estimate of household income, as defined in § 435.603 of this part, determined using simplified methods prescribed by the agency) at or below the income standard established by the State for the age of the child under § 435.118(c) or under § 435.229 if applicable and higher.
(2) Establish procedures to ensure that qualified entities -
(B) If a Medicaid application on behalf of the child is filed by the last day of the following month, the child's presumptive eligibility will end on the day that a decision is made on the Medicaid application.
(A) Of the reason for the determination; and
(vi) Do not delegate the authority to determine presumptive eligibility to another entity.
(3) Establish oversight mechanisms to ensure that presumptive eligibility determinations are being made consistent with the statute and regulations.
(d) The agency -
(1) May require, for purposes of making a presumptive eligibility determination under this section, that the individual has attested to being, or another person who attests to having reasonable knowledge of the individual's status has attested to the individual being, a -
(i) Citizen or national of the United States or in satisfactory immigration status; or
(ii) Resident of the State; and
(2) May not -
(i) Impose other conditions for presumptive eligibility not specified in this section; or
(ii) Require verification of the conditions for presumptive eligibility.
- 42 CFR 457.300 — Basis, Scope, and Applicability.
- 42 CFR 457.355 — Presumptive Eligibility for Children.
- 42 CFR 435.1103 — Presumptive Eligibility for Other Individuals.
- 42 CFR 431.865 — Disallowance of Federal Financial Participation for Erroneous State Payments (For Annual Assessment Periods Ending After July 1, 1990).
- 42 CFR 435.1110 — Presumptive Eligibility Determined by Hospitals.