Presumptive Eligibility

 

Qualified hospital personnel can use this guide to start a Presumptive Eligibility Application for any Medicaid-eligible individual.

 

 

 

From the Home Page access the Admin Dashboard screen.

 

The system does not perform any verifications or MCI checks for presumptive eligibility applications. After completing a Presumptive Eligibility Application, the full application can be completed by Presumptive Eligibility hospital staff or by the individual himself/herself.

 

 

 

 

 

 

 

 

If the applicant is determined by a qualified hospital, on the basis of preliminary information, to be presumptively eligible, presumptive eligibility will be effective only until the end of next month or until a full application is received before the end date and eligibility is determined.  To continue to receive coverage after the presumptive eligibility period expires, the individual is required to complete a full application.

 

 

 

 

 

 

 

 

Process Steps

 

To start a Presumptive Eligibility application:

 

1.      Click the Start Presumptive Eligibility Application link in the Individual Administration section of the Admin Dashboard.

·        The Presumptive Eligibility Application – Primary Applicant Information is displayed.

2.      Enter the applicant’s first, middle and last name in the First Name, Middle Name and Last Name textboxes.

3.      Enter the primary applicant’s address in the Address Line 1, Address Line 2 and Apt/Unit# textboxes.

4.      Enter the primary applicant’s city in the City textbox.

5.      Select the primary applicant’s state from the State drop-down menu.

6.      Enter the primary applicant’s zip code in the Zip Code textbox.

7.      If known, enter the primary applicant’s date of birth in format MM/DD/YYYY the Date of Birth textbox or select it from the calendar

8.      If known, enter the primary applicant’s social security number in the Social Security Number textbox.

9.      Check the box to indicate “This person is applying for Presumptive Eligibility”.

10.   Click Next.

·        The Presumptive Eligibility Application – Your Household Members screen is displayed.

11.   Select the name of the hospital from the Hospital Name drop-down menu.

12.   If known, enter the applicant’s primary phone number in the Primary Phone Number textbox.

13.   If known, select the applicant’s primary phone number type from the Type drop-down menu.

14.   If known, enter the applicant’s secondary phone number in the Secondary Phone Number textbox.

15.   If known, select the applicant’s secondary phone number type from the Type drop-down menu.

16.   If known, enter the applicant’s email in the Email Address textbox.

17.   Enter information about the presumptive primary applicant:

  1. Enter the first name of the account’s primary applicant in the First Name textbox.

  2. Enter the middle name of the account’s primary applicant in the Middle Name textbox.

  3. Enter the last name of the account’s primary applicant in the Last Name textbox.

  4. Enter the date of birth of the account’s primary applicant in the Date of Birth textbox in the format MM/DD/YYYY or select it from the calendar.

  5. Select the applicant gender with the Gender radio button.

  6. If the applicant is a female, indicate if the applicant is pregnant in the Is this person pregnant? radio button.

  7. If known and the applicant is pregnant, select it from the Number of Babies Expected drop-down menu. If a number is not entered, the system will assume one baby is expected.

  8. If known, select the radio button to indicate if Is this person a parent/caretaker? If not answered, the system will assume the applicant is not a parent/caretaker.

  9. If known, enter the applicant’s social security number in the Social Security Number textbox in the format XXX-XX-XXXX.

  10. Select the radio button to indicate if the applicant is a US citizen or national.

  11. If the applicant is not a US citizen or national, select the radio button to indicate if he/she has an eligible immigration status.

  12. Select the radio button to indicate if the person has in the Rhode Island foster care system on his or her 18th birthday.

18.   If additional members of the household are applying for presumptive eligibility, click the Add Member button.

 

The same information needs to be entered for secondary presumptive eligibility applicants under the same account.

 

 

19.   Enter the monthly household gross income in the Household Current Gross Monthly Income textbox.

20.   Enter the monthly household deductions in the Household Total Monthly Deductions textbox.

21.   Enter the number of additional people that live in the household excluding the applicants entered above (unborn children not included above should be included here).

22.   Read the text on the Electronic Signature screen to the applicant.

23.   Check the box to attest the applicant’s signing of the application.

24.   Enter the applicant’s first, middle and last name in the First Name, Middle Name and Last Name textboxes.

25.   Click Next.

·        The Eligibility Determination screen is displayed.

If the applicant is determined by a qualified hospital, on the basis of preliminary information, presumptive eligibility is effective only until the end of next month.  To continue receiving coverage after the presumptive eligibility period expires, the individual is required to complete a full application.

 

 

 

 

 

26.   Click Next.

·        The Admin Dashboard is displayed.

At this point, the system generates a username and password for the applicant. If the individual decides to complete an application, they can do so using these credentials.

 

 

 

 

 

 

Results of the Procedure

 

A presumptive eligibility application is submitted.

 

The applicant’s eligibility status is determined by the system.

 

A username and password are generated for the applicant.