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Presumptive Eligibility

Home and Community Based Care/Community Providers

The Bureau of Family Assistance (BFA) in partnership with the Bureau of Elderly and Adult Services (BEAS) are implementing RSA 151-E: 18, Presumptive Eligibility (PE) for the Choices for Independence (Home and Community Based Care for the Elderly and Chronically Ill) Medicaid Program. BFA is waiving the normal face-to-face financial interview with an applicant. Please contact ServiceLink.

Qualified Entities (QEs) & Qualified Hospitals (QHs) Who Determine PE for MAGI MA

An entity or hospital that furnishes health care services and is enrolled with DHHS to receive Medicaid payments as a Medicaid provider, must do the following if they wish to determine PE for certain medical assistance programs:

  • notify DHHS that they wish to determine PE via providing DHHS with a completed DFA Form 820 Adobe Acrobat Reader Symbol, Request to Determine Presumptive Eligibility (PE)
  • attend a training on the eligibility criteria for MAGI medical coverage groups and score an 85% or higher on a written exam following the training;
  • maintain certification by, among other requirements, applying PE eligibility requirements consistently and accurately during each PE determination, verifying that the individual is authorized for the PE period, and verifying that the individual is not already a Medicaid applicant; and
  • participate in retraining and retesting, and potentially be disqualified from determining PE, if DHHS finds that the certified entity or hospital fails to adhere to the requirements of determining PE.

Entities and hospitals who are successfully certified by DHHS are referred to as qualified entities (QEs) and qualified hospitals (QHs) and are certified to make PE determinations for a limited period of temporary medical assistance coverage. This temporary PE medical coverage is provided to individuals who have been determined to have met PE eligibility requirements on the basis of limited, preliminary, self-attested information provided by the PE applicant on DFA Form 821 Adobe Acrobat Reader Symbol, Application for Medicaid Presumptive Eligibility (PE), for the following MAGI-related medical assistance coverage groups only:

  • Children's Medicaid (CM), Expanded CM, and Children with Severe Disabilities (CSD);
  • Pregnant Women Medical Assistance (MA);
  • Family Planning Medical Assistance (FPMA);
  • Parent/Caretaker Relative MA; and
  • NH Health Protection Program (NHHPP/NHHPP-M).

Note: Certified QHs, but not certified QEs, can additionally determine PE for Former Foster Care Child MA.

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