AHCA: Qualified Hospital (QH) Presumptive Eligibility

Qualified Hospital (QH) Presumptive Eligibility

Florida Medicaid enrolled hospital providers may elect to make presumptive eligibility determinations in accordance with federal law and state policy.

Qualified hospitals (QH) may make presumptive eligibility determinations for:

Pregnant women
Infants and children under age 19
Parents and other caretaker relatives
Former foster care children

Provider Qualifications

Hospitals must meet the following qualifications in order to become qualified to determine presumptive eligibility:

Be enrolled in the Florida Medicaid program as a hospital provider (provider type 01)
Complete and submit the Institutional Medicaid Provider Agreement for QH Electing to Make Presumptive Eligibility Determinations [ 253.5 kB ]

QH Enrollment Coordinator
Medicaid Fiscal Agent Operations Bureau Chief
2727 Mahan Drive, Mail Stop 22
Tallahassee, Florida 32308

Ensure all employees who are authorized to make presumptive eligibility determinations complete the training certification requirements and maintain documentation of these certifications in a central location
Make determinations consistent with state eligibility policy
Assist individuals with submitting full Medicaid eligibility applications and supporting documentation within certain timeframes
Continually meet the following performance standards:
- During the first 18 months of enrollment as a Qualified Hospital:
  - 90% of individuals determined to be presumptively eligible will submit a regular application before the end of the presumptive eligibility period.
  - Average (mean) days from date of presumptive eligibility determination to date of application submission is less than 10 calendar days.
  - 90% of the individuals who submit an application before the end of the presumptive eligibility period will be determined eligible for regular Medicaid.
- After the first 18 months of enrollment as a Qualified Hospital:
  - 95% of individuals determined to be presumptively eligible will submit a regular application before the end of the presumptive eligibility period.
  - Average (mean) days from date of presumptive eligibility determination to date of application submission is less than 10 calendar days.
  - 97% of the individuals who submit an application before the end of the presumptive eligibility period will be determined eligible for regular Medicaid.