177 PRESUMPTIVE ELIGIBILITY (PE) (MAM)

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Presumptive Eligibility (PE) is a period of temporary medical assistance for categories of Medicaid that use modified adjusted gross income (MAGI) in the eligibility determination process. PE does not apply to any category of Medicaid that does not use MAGI in the eligibility determination process.

A Qualified Hospital (QH) or Qualified Entity (QE) determines if an individual is eligible for PE based on the following self-attested, limited, preliminary PE information provided by the applicant on DFA Form 821, Application for Medicaid Presumptive Eligibility (PE):

• the individual meets the categorical requirements for the appropriate MAGI-related coverage group;

• the household income does not exceed the applicable income standards for the applicable HH size and MAGI-related coverage group;

• the individual attests to being a NH resident; and

• the individual attests to US citizenship or acceptable immigration status.

References: PART He-W 843, 42 CFR 435.1100 - 42 CFR 435.1110, 42 USC 1396r-1, 42 USC 1396r-1a, 42 USC 1396r-1c