Hospital Presumptive Eligibility program

Hospitals may become qualified to participate in HPE by completing the following:

• Be enrolled as a provider with Minnesota Health Care Programs (MHCP) and complete the Hospital Presumptive Eligibility Applicant Assurance Statement (DHS-3887) (PDF) addendum to their provider agreement.
• Participate in required training. Hospitals will need to submit the names and HPE Learning Center identification number of a minimum of two hospital staff members who have passed the training on Hospital Staff Who Passed DHS Hospital Presumptive Eligibility Online Training Course (DHS-3889) (PDF).
• Agree to follow MHCP policies and procedures for eligibility determinations. Refer to the HPE Policy Guide (DHS-7267) (PDF) and the HPE Procedures Guide (DHS-7267A) (PDF).
• Help people the hospital has approved for HPE complete and submit the online application through MNsure.org or fill out the paper Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF). Hospitals also may offer them information on other help available, such as through a navigator.
• Meet established performance standards.
• 80 percent of the people approved for HPE by the hospital must go on to file an application through MNsure either online or on paper within 30 days of the end of the HPE coverage period.
• 80 percent of the people who file a MNsure application are determined eligible for MA.

Hospital staff or third party contractors must complete the HPE application for individuals who are seeking HPE coverage. HPE determinations are based on preliminary information that the applicant or the person designated by the applicant provides about the following: 

• Applicant’s household size 
• Countable income of the applicant and his or her household members 
• Applicant’s citizenship or immigration status 
• Applicant’s MA eligibility group 
• Applicant’s state residency 

Hospitals may not:

• Request verifications from the patient.
• Require applicants to provide a Social Security number.

Eligibility categories 

Applicants must have an MA basis of eligibility under one of the following categories to be eligible under HPE:

• Pregnant people
• Children under age 21
• Parents and caretakers
• People under age 26 who were in foster care at age 18 (no income limit)
• Adults without children (between the ages of 19 and 64)

Individuals receive regular MA services during the HPE period.

Eligibility period

The HPE eligibility period begins the date the hospital approves HPE. HPE ends on either of the following dates, whichever is earliest: 

• The date on which DHS makes the eligibility determination for MA if the person files an application through MNsure, either online or on paper. 
• The last day of the month following the month in which the person is approved for HPE 

Individuals are limited to one HPE period every 12 months. Women who become pregnant may have one HPE period during each pregnancy.

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