Presumptive Eligibility Florida Medicaid

UPDATE for FLORIDA MEDICAID Florida Medicaid has streamlined and simplified the materials for Presumptive Eligibility training for hospitals on their website. Updated presentations were posted Feb. 13, 2017 The link to the materials is here: Hospital Presumptive Eligibility

What is Presumptive Eligibility? Hospitals can temporarily and immediately enroll patients and their families in Medicaid without having to wait for a full eligibility determination from the state. If the individual or family submits a full application by the end of the month following the month a PE determination is made, the PE period will last until a full Medicaid determination is made. If the individual or family does not submit a full Medicaid application, the PE period will last until the end of the month following the month in which the presumptive eligibility determination is made. 

PE Example A patient is found to be presumptively eligible at your hospital on January 15th. They will remain eligible until February 28th and all claims will be paid during that period. If a full Medicaid application is completed they will remain presumptively eligible until a final eligibility is determined.

Who is Eligible? Pregnant Women Infants and children under 19 years Parents and other caretaker relatives Former foster care children

Florida Guidelines Hospital must be a Medicaid provider Authorized employees must complete training and keep it up to date Follow state policy for eligibility determinations Assist individuals with full Medicaid applications Meet performance standards 95% of PE patients will submit full application 90% of those submitting application will qualify for regular Medicaid

MOON Implementation Webinar MARCH 2nd @ 10 am CST New instructions were just published, we will review them and discuss an exciting option exclusive to HTH for delivery of instructions! Don’t Miss This Webinar!

Sandy.Sage@hometownhealthonline.com