37.79.117    PRESUMPTIVE ELIGIBILITY

(1) A family applies for a period of presumptive eligibility (PE), defined as temporary enrollment in the HMK coverage group not to exceed two consecutive calendar months within a 12-month period, for all of their uninsured children less than 19 years of age.

(a) To apply for PE, a parent or guardian submits a PE application to a qualified entity (QE).

(i) The parent or guardian must complete the entire PE application and sign it as indicated.

(b) The QE makes a determination of PE based on self-declared information provided by the applicant on the PE application including family size, gross monthly income, citizenship, and residency.

(i) PE determinations are effective beginning the date a QE makes the determination through the earlier of:

(A) the last day of the month following the PE determination month; or

(B) the date the department makes an eligibility determination.

(ii) If the children are approved for PE, the QE provides the parent or guardian with an HMK Plan application and explains how to submit the application and all needed documentation to HMK.

(iii) If the child(ren) are determined ineligible for PE, the QE provides the parent or guardian with the specific reason for the PE denial.

(c) The parent or guardian is responsible for submitting a completed HMK application and all needed documentation to HMK no later than the last day of the month following the month of the PE determination.

(d) The department makes the HMK coverage group determination based on information provided on a completed HMK Plan application that includes documentation. If eligible, a child remains enrolled in the HMK Plan. If ineligible, the child is disenrolled.

(e) Presumptively eligible children receive the same benefits as all children in the HMK coverage group.

(f) Children may not have more than one PE period during a 12-month span. The 12-month span begins with the date a QE determines eligibility.

History: 53-4-1009, 53-4-1105, MCA; IMP, 53-4-1004, 53-4-1102, 53-4-1103, 53-4-1104, 53-4-1105, 53-4-1108, MCA; NEW, 2011 MAR p. 70, Eff. 1/1/11.