Section He-W 619.04 - Presumptive Eligibility Determination Process(a) A written referral for presumptive eligibility shall be initiated by the individual or qualified provider and transmitted to the department with a completed medicaid application and medical eligibility determination (MED) application, unless these forms had been filed within the prior 60 days.(b) An individual referred for presumptive eligibility shall undergo a face-to-face clinical assessment and the department shall review the medicaid application to verify presumptive eligibility.(c) The clinical assessment shall take place before or after the review of the completed application by the department, but no later than 20 business days after the referral for presumptive eligibility is received from the qualified provider or individual. The clinical assessment shall include the development of an initial support plan, if the individual is found to be clinically eligible.(d) The department shall review the medicaid application for categorical and financial eligibility, prior to or after the clinical assessment, but no later than 5 business days after the clinical assessment is completed.(e) An applicant shall not be eligible for a presumptive eligibility authorization if his or her financial eligibility is contingent upon a legal review of a trust instrument or annuity or investigation of any known complex issues such as asset transfers that could preclude eligibility.(f) Medicaid service coverage shall begin immediately upon: (1) A finding of presumptive eligibility;(2) Completion of a support plan; and(3) The applicant's written acknowledgement of the responsibility described in He-W 619.02(a) (8) . (g) Presumptive eligibility shall continue until a final determination of eligibility or ineligibility.N.H. Admin. Code § He-W 619.04
#5171, eff 6-26-91; EXPIRED: 6-26-99
New. #9155, eff 5-10-08
Amended by Volume XXXVI Number 23, Filed June 9, 2016, Proposed by #11104, Effective 5/25/2016, Expires 11/21/2016.