131.01 Presumptive Eligibility SR 99-36, 06/99 (FAM-A)

Certain agencies authorized to use Form 800P, Application for New Hampshire Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women, may also make presumptive eligibility determinations. Presumptive eligibility is a process in which a qualified entity (community outreach agency staff who have attended DFA training on presumptive eligibility policy) makes a preliminary eligibility decision based on an interview with the applicant and documentation available at the interview.

Consecutive presumptive eligibility determinations are prohibited without an intervening period of receipt of medical assistance for which the District Office has conducted a full eligibility determination and verified all pertinent eligibility criteria. Once an individual has been determined presumptively eligible for HKG-185 or HKG-300 medical coverage or MCPW, that individual is only allowed to have another presumptive eligibility determination after the individual:

• Was determined eligible for medical assistance by the DHHS District Office and received such assistance after the presumptive eligibility period ended; and

• Subsequently became ineligible for medical assistance.

The agency worker has 5 working days to provide a notice of determination to the individual and the District Office using Form 800P.