09/15/15
Informational Notice
MPE Provider Alert Participating Federally Qualified Health Centers (FQHC), Encounter Rate Clinics, Local Health Departments, Rural Health Clinics, School Based Health Clinics, School Based/Linked Health Center Services, Hospital Based Clinics
Re: All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Provider Alert
Dear Provider,
An
All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Provider Alert is posted to the HFS website for your review.
The Medicaid Presumptive Eligibility (MPE) Instructions for providers manual is revised and posted on the HFS website for your review. Additionally, the following MPE forms are revised and are attached to this notice for your immediate use. If you have any questions about this communication or the MPE program, please contact an All Kids liaison:
AKAA Liaison for those located North of I-80
Phone: 1-312-793-5270 Fax: 1-312-793-5278
AKAA Liaison for those located South of I-I80
Phone: 1-217-524-7156 Fax: 1-127-557-4274 .
All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Provider Alert for September 2015
- Proof of Pregnancy
- MPE Limit per Pregnancy
- Social Security Number Requirement for MPE on abe.illinois.gov
- Declaration of Illinois Residency
- Countable Income for MPE
- Family Size Based on Age
- Medicaid Presumptive Eligibility Instructions for Providershas been revised and is online
- Revised Form 3089 Medicaid Presumptive Eligibility Application
- New Form 3090D MPE Denial Notice
- Fact Sheet on Presumptive Eligibility for Children and Pregnant Women
- Attachments: Forms 3089, 3090D, 3166
Proof of Pregnancy
The Affordable Care Act (ACA) removed the requirement for verification of pregnancy. Therefore, proof of pregnancy is not required of applicants for the Medicaid Presumptive Eligibility (MPE) program or any other Illinois Medicaid program including Moms & Babies. Accept the applicant’s statement of pregnancy. Please enter the estimated date of delivery on the MPE application in ABE or paper application if it is known.
Until the online MPE application in ABE is updated to ask about declaration of pregnancy and the date the pregnancy was declared, use this Alert as guidance regarding pregnancy.
MPE Limit per Pregnancy
The Affordable Care Act (ACA) limits MPE to one approval per pregnancy. However, HFS will extend the MPE until a final determination of eligibility is made if an application for full medical benefits has been submitted before the initial MPE coverage period ends.
Social Security Number (SSN) Requirement for MPE on abe.illinois.gov
The online application for full medical benefits requires an SSN if the person has an SSN. However for MPE, the SSN is optional.
Until the online ABE MPE application is updated, applicants who choose not to provide an SSN can mark ‘SSN not available’.
We ask that you encourage MPE applicants who have an SSN to provide it because it helps the Department link the MPE applications to the full Moms & Babies application if submitted, and it expedites authorization of the MPE coverage.
Declaration of Illinois Residency
Applicants for MPE must state they are Illinois residents. However, there is no requirement defining how long they have been an Illinois resident.
Countable Income for MPE
The MPE income eligibility determination is revised to bring it into alignment with the budgeting methodology used for children’s presumptive eligibility. To determine MPE eligibility, compare the gross monthly income of everyone who is included in the pregnant woman’s family size to the MPE income standard. Do not deduct any amount from the gross monthly income.
Until the online ABE MPE application is updated, do not enter an amount in the Income Deduction section. Determine countable monthly income based on this Alert.
MPE Form 3166
MPE Income Worksheet is updated to reflect this change and is attached.
Family Size Based on Age
Family size is considered when determining whether the pregnant woman meets the income standard for MPE. Family is defined as the pregnant woman, her unborn child(ren), her husband, and children/stepchildren under the age of 19. If the pregnant woman is under the age of 19 and lives with her parents/stepparents, then the parents and any siblings under age 19 are counted in the family size in addition to her husband, unborn child(ren) and her existing children under 19.
Until the online ABE MPE application help text is updated, determine family size based on this Alert.
Medicaid Presumptive Eligibility Instructions for Providers has been revised and is online.
Revised Form 3089 Medicaid Presumptive Eligibility Application
Form 3089 is revised to add the declaration of pregnancy question, add the declaration of Illinois residency question, clarify that the SSN is optional and to clarify the MPE eligibility begin date. Use the Form 3089 attached to this alert. The form included in the
Medicaid Presumptive Eligibility Instructions for Providers has a watermark on it to prevent unauthorized use.
Form 3090D MPE Denial Notice
Federal regulations require notifying the applicant when she does not qualify for presumptive eligibility. Use one of the following reasons to deny MPE coverage to an ineligible pregnant woman:
- Income exceeds the limit for MPE;
- MPE coverage limited to one time per pregnancy;
- Applicant stated she is not pregnant;
- Applicant stated she is not an Illinois resident; or
- Information needed for an eligibility determination was not provided.
When the applicant fails to provide information about household income or the number of people living with her or will not declare she is pregnant or is an Illinois resident, the applicant is not eligible for MPE.
Until the online ABE MPE application PDF Summary page is updated, use the attached form 3090D/S to notify the pregnant woman of the reason for denial.
If the applicant’s income is over the limit, she may still qualify for Medicaid with a spenddown. Help the applicant complete and submit a Moms & Babies application.
Presumptive Eligibility for Children and Pregnant Women
We would like to clarify the requirements for child presumptive eligibility and MPE for pregnant women.
- Applicants must be informed of the minimum information required to start medical coverage right away. However, we also want applicants to understand that a complete application is required to determine eligibility for medical coverage following the presumptive eligibility period;
- Verification of pregnancy is no longer required for MPE eligibility;
- An applicant for a child must declare the child’s U.S. citizenship or satisfactory immigration status; and
- Applicants are required to declare their Illinois residency. Declaration of Illinois residency means answering the question, “Are you an Illinois resident?”
