Iowa Admin. Code r. 441-76.7 - Presumptive eligibility

Individuals may be temporarily enrolled in Medicaid based on a presumptive eligibility determination by a qualified entity pursuant to this rule.

(1) For eligibility effective prior to January 1, 2014.

a. Applicants for presumptive eligibility for children will complete Application: Presumptive Health Care Coverage for Children, Form 470-4855 or 470-4855(S).

b. Applicants for presumptive eligibility for pregnant women or for presumptive eligibility for breast and cervical cancer coverage group shall complete Health Services Application, Form 470-2927 or Form 470-2927(S).

(2) For eligibility effective on or after January 1, 2014. Applicants for presumptive eligibility will complete Application for Health Coverage and Help Paying Costs, Form 470-5170 or 470-5170(S).

(3) How and where to file. Applications for presumptive eligibility are filed at the office of a qualified entity for presumptive Medicaid eligibility determinations.

(4) Enrollment. An individual is enrolled on the date that presumptive eligibility is determined by the qualified entity.

(5) Notice and appeal rights. Timely and adequate notice requirements and appeal rights of the Medicaid program shall not apply to presumptive eligibility decisions made by a qualified entity.

(6) Full medical assistance eligibility determination. All presumptive eligibility applications shall receive a full determination of eligibility for Medicaid or HAWK-I except for breast and cervical cancer and pregnant women coverage groups.

Notes

Iowa Admin. Code r. 441-76.7

ARC 1069C, IAB 10/2/2013, effective 10/1/2013