Section 210-RICR-30-00-4.3 - Scope and Purpose of Hospital Presumptive Eligibility Program for MedicaidA. For individuals with MACC-like characteristics, presumptive eligibility may be determined by a qualified hospital, licensed in Rhode Island, and is only available in certain circumstances contingent upon preliminary information supplied by the individual. Further, presumptive eligibility is only available on a temporary basis - until the last day of the month following the initial determination of presumptive eligibility or the date full eligibility is determined, whichever comes first.1. Implementation - Effective January 27, 2014, the State will accept applications from qualified hospitals that wish to make presumptive eligibility determinations pursuant to 42 C.F.R. § 435.1110. If a qualified hospital determines that an individual meets the characteristics of one of the MACC groups identified in Part 30-00-1 of this Title (and as below) they will be granted eligibility2. Governing Provisions - The purpose of these rules is to set forth the provisions governing hospital presumptive eligibility determinations including, but are not limited to the: a. Populations for which qualified, participating hospitals may conduct presumptive eligibility assessments and scope of coverage;b. Requirements for a hospital to participate in the Hospital Presumptive Eligibility Program;c. Application timelines and procedures for individuals who qualify for Medicaid coverage during the presumptive eligibility period.210 R.I. Code R. 210-RICR-30-00-4.3
Amended effective 12/25/2024