Section 405IAC2-3.2-3. Application; qualified providers to establish presumptive eligibility; presumptive eligibility criteria

   (a) An application for presumptive eligibility must be made to a qualified provider.

  (b) A qualified provider shall establish presumptive eligibility if the:

(1) woman is pregnant, as evidenced by a verifiable pregnancy;

(2) qualified provider determines, on the basis of preliminary information provided by the woman, that the:

(A) gross family income of the woman does not exceed the amount set forth in IC 12-15-2-13;

(B) woman is an Indiana resident;

(C) woman is a United States citizen or a qualified alien, as defined in 8 U.S.C. 1641, who has resided in the United States for at least five (5) years; and

(D) woman is not an inmate of a public institution;

(3) woman is not currently enrolled in Medicaid; and

(4) woman has not previously been granted presumptive eligibility for her current pregnancy.

  (c) If a qualified provider establishes presumptive eligibility for a woman, the qualified provider must:

(1) notify the office of the determination within five (5) business days after the date the determination is made; and

(2) inform the woman at the time the determination is made that she is required to apply for Medicaid not later than the last day of the month following the month during which the presumptive eligibility determination is made.

  (d) If a qualified provider determines that presumptive eligibility cannot be established, the qualified provider shall inform the woman in writing:

(1) of the reason for the determination; and

(2) that she may file an application for Medicaid if she wishes to have a formal determination made.

(Office of the Secretary of Family and Social Services; 405 IAC 2-3.2-3; filed Mar 19, 2010, 11:15 a.m.: 20100414-IR-405090262FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA)