177.05 Length of PE Period (MAM)

____________________________________________________________

The presumptive eligibility (PE) period begins on the date the individual is determined eligible by the Qualified Hospital (QH)/Qualified Entity (QE) for PE and ends on:

. the date the determination of eligibility, or ineligibility, for full Medicaid is made by DHHS, if an application for full Medicaid is filed by the last day of the month following the month in which the determination of PE is made; or

. the last day of the month following the month in which the determination of PE is made if no application for full Medicaid is filed by that date.

Individuals are limited to one (1) PE period per calendar year or, if pregnant, one (1) PE period per pregnancy.

Notices of Decisions (NODs) are not issued when PE closes, and individuals cannot appeal the closing of PE, per 42 CFR 435.1102(e).

Examples of when the PE period ends:

An individual is determined presumptively eligible by a QH or QE on June 1st.

. The individual does not file an application for full Medicaid during the PE period. This individual's PE period will end on the last day of the PE period, July 31st.

. The individual files an application for full Medicaid on June 3rd, and is determined ineligible for Medicaid on June 10th. This individual's PE period ends on June 10th.

. The individual files an application for full Medicaid on June 3rd, and is determined eligible for Medicaid on June 12th. This individual's PE period ends on June 12th.

. The individual files an application for full Medicaid on the last day of the PE period, July 31st, and is determined ineligible for Medicaid on August 25th. This individual's PE period ends August 25th.

This individual cannot be determined eligible for a new PE period for the remainder of the calendar year. However, if the individual is pregnant, she cannot receive a new PE period for the remainder of the calendar year unless she becomes pregnant again during the same calendar year.

Examples of when the individual is eligible for a new PE period:

. An individual determined eligible for PE on July 25th is not eligible for another PE period until January 1st of the subsequent year, unless the individual becomes pregnant.

. A pregnant individual determined eligible for PE on July 25th, would not be eligible for another PE period until:

- she experiences a new pregnancy in the current year; or

- January 1st or later of the subsequent year, if she is no longer pregnant.

. An individual determined eligible for PE on July 25th (whether based on pregnancy or not), who then becomes pregnant in December of the same year, is eligible for another PE period beginning with the date of her pregnancy in December.

References: He-W 843.01(c), 42 CFR 435.1101, 42 CFR 435.1102(c) & (e)