Medical Assistance for Families with Children and Adults

2.2.1.1 Hospital Presumptive Eligibility

The Hospital Presumptive Eligibility (HPE) program allows participating hospitals to determine temporary eligibility for Medical Assistance (MA) for people who meet the basic criteria for Medical Assistance for Families with Children and Adults (MA-FCA). See the Hospital Presumptive Eligibility web site for additional program information.

Individuals eligible to apply for HPE

A person does not need to be a patient at a hospital or hospital clinic to apply for HPE. Qualified hospitals are required to process applications for individuals regardless of whether the applicant is seeking medical treatment.

HPE Determination

Hospital staff who have been certified by the Minnesota Department of Human Services (DHS) are responsible for making HPE eligibility determinations. The HPE eligibility determination must be based only on the preliminary information an applicant provides. Hospitals cannot request verifications from an applicant.

Non-Financial Eligibility for HPE

HPE non-financial eligibility rules follow MA-FCA non-financial eligibility rules with the following exceptions:

  • An HPE applicant is not required to provide his or her Social Security number as a condition of eligibility.

  • HPE household composition rules follow non-tax filer household composition rules for MA-FCA, regardless of the applicant’s tax filing status.

An HPE applicant must be a Minnesota resident to be eligible.

People who are incarcerated are not eligible for HPE. See the MA for Hospitalized Incarcerated People chapter for more information.

Basis of Eligibility

HPE applicants must have an MA-FCA basis of eligibility under one of the following categories:

  • Infants and children age 0-2

  • Children age 2-18

  • Children age 19-20

  • Parents and relative caretakers

  • Pregnant women

  • Adults without children aged 21-64, without Medicare

  • People under age 26 who were in foster care at age 18 (no income limit)

HPE is not available for people under other MA bases of eligibility.

Current Minnesota Health Care Programs Eligibility

People who currently are enrolled in MA or MinnesotaCare are ineligible for HPE. Hospitals are required to confirm that an applicant does not have current MA or MinnesotaCare coverage before approving HPE eligibility.

Enrollees of the Consolidated Chemical Dependency Treatment Fund or HIV/AIDS Program are eligible for HPE coverage if they are not also enrolled in MA. People enrolled in the Minnesota Family Planning Program (MFPP) are eligible for HPE.

Financial Eligibility for HPE

Applicants must meet certain financial requirements for HPE eligibility. The HPE financial eligibility rules are a simplified version of the regular MA-FCA financial eligibility rules. HPE financial eligibility differs in the following ways:

  • HPE income limits are the same as MA-FCA income limits, but hospitals apply the five percent disregard when determining HPE eligibility. Refer to HPE Income and Asset Guidelines (DHS-3884) for more information.

  • Sponsor deeming rules do not apply when determining HPE eligibility.

  • HPE financial eligibility rules do not allow deductions from gross income allowed under the modified-adjusted gross income based (MAGI-based) methodology.

  • The income of a child under age 19 who lives with the applicant does not count towards the HPE household income unless the child is expected to earn more than $6,000 in the current year.

See the MA-FCA Financial Eligibility section for more information.

HPE Eligibility Period

The HPE eligibility period begins the date the hospital approves HPE. The HPE period ends:

  • the date ongoing MA eligibility is determined if the HPE enrollee submits an application for MA during the HPE eligibility period.

  • the last day of the month after the month HPE eligibility was approved if the HPE enrollee does not submit an application for MA during the HPE eligibility period.

Frequency of HPE Availability

People are limited to one HPE period every 12 months.

Women who become pregnant can have one HPE period during each pregnancy.

Covered Services

HPE enrollees are eligible to receive regular MA services during the HPE period.

Service Delivery

HPE coverage is provided on a fee-for-service basis. HPE enrollees can receive any MA-covered service from a provider that participates in the fee-for-service MA program.

Ongoing MA Coverage

After a hospital approves a person for HPE, the hospital must help the person file the online or paper application for ongoing coverage. Hospitals may refer people to a certified assister or navigator to help the person complete the online or paper application form. See the Application Forms policy for more information.

Appeal Rights

HPE applicants cannot appeal an HPE eligibility determination.

Legal Citations

Code of Federal Regulations, title 42, section 435.1102

Code of Federal Regulations, title 42, section 435.1103

Code of Federal Regulations, title 42, section 435.1110

Minnesota Statutes, section 256B.057

Social Security Act, section 1902

United States Code, title 42, section 1936a