WAG 06-10-02: Eligibility

PM 06-10-02

(FCRC/All Kids Unit) revised textApprove medical benefits for an MPE client the day the MPE application is received. This allows the woman to receive outpatient medical care during the application process.

(FCRC/All Kids Unit) Complete Form 552:

Item 1 - Complete
Item 2 - Enter the date (MMDDYY) from the Application Date in Section III of the Medicaid Presumptive Eligibility Application (Form 3089).
Item 3 - Enter TA 10
Item 5 - Complete
Items 8  - 10 - Complete
Item 33 - Enter the correct TAR:
  • 45 - to approve initial MPE eligibility period from the MPE decision through the last day of the month after the month of the MPE decision.
  • 47 - revised textto approve a 90-day eligibility period for an MPE eligible client who applies for ongoing benefits before the expiration of her initial MPE eligibility period.
  • 49 - revised textto approve a 45-day eligibility period for an MPE client with a pending application.
Item 39 - Enter 80
Item 60 - Complete
Item 66 - Enter 2
Item 69 - Enter 1

revised textComplete Form 552 for a woman in spenddown who gets a 15-day eligibility period the same as above except:

Item 2 - Enter the month and year of the MPE Application Date (MMYY)
Item 3 - Enter TA 55
Item 33 - Enter TAR 45
Item 77 - Enter the MPE application date

The MPE eligibility period(s) is shown on the MMIS Medical Eligibility File below the Special Program Eligibility section. For these cases, M will appear in the code field.

revised textThe Medical Electronic Data Interchange (MEDI) Authorization System alerts medical providers that the person is participating in the Healthy Start/Medicaid Presumptive Eligibility Program and that inpatient or long term care services are not authorized.