Minnesota Family Planning Program

4.1.1.3 Presumptive Eligibility

Presumptive eligibility (PE) is a temporary period of eligibility that is determined by a Certified MFPP Provider using preliminary information.

Presumptive Eligibility Begin and End Dates

The PE period begins the date the Certified MFPP Provider approves PE. The PE period ends:

Minnesota Residency

An applicant must be a resident to qualify for PE. An applicant must provide a Minnesota address, or if homeless, indicate they live in a Minnesota county, to be considered a Minnesota resident.

An applicant age 21 or older must also indicate they plan to make Minnesota their home to meet residency requirements.

Income

PE is determined using attested household income, which is a person's reasonable estimate of household income. Certified MFPP Providers cannot request verification of income from an applicant for the purpose of determining PE eligibility.

The household income of applicants age 21 or older includes the attested income of all members of the applicants household composition.

The household income of applicants under age 21 includes only the applicant's attested income.

Household Composition

Refer to Section 4.1.3.1 MFPP Household Composition for information about household composition for presumptive eligibility.

Refer to  Section 1.4.4 Minnesota Health Care Programs (MHCP) Temporary Absence for information about household members who are temporarily living apart.

Notice      

The Certified MFPP Provider gives the applicant a MFPP Short-Term Approval Notice or a MFPP Short-Term Denial Notice. The provider then submits the application to the Department of Human Services (DHS) Health Care Eligibility Operations for a full eligibility determination.

Appeals

Applicants cannot appeal a denial of MFPP presumptive eligibility. They may appeal a denial of a full eligibility determination following the MHCP Appeals policy.

Certified MFPP Providers

People may search for a certified provider in the Minnesota Health Care Program Provider Directory using the provider type “Family Planning Services” and sub type “Certified MFPP Provider.”

General information about MFPP is available in the Minnesota Family Planning Program brochure (DHS-4750).

Legal Citations

Centers for Medicare and Medicaid Services (CMS) State Medicaid Director Letter Re: Family Planning Services Option and New Benefit rules for Benchmark Plans (July 2, 2010)

Minnesota Statutes, section 256B.78

Patient Protection and Affordability Care Act, Public Law 111-148, section 2303

United States Code, title 42, section 1396r-1c