Module 3 A Completing the Determination Letter 2

Module 3 A: Completing the Determination Letter

2 Module 3 A: Determination Letter • Part A • Practice Scenario • Determination Letter for Presumptive Eligibility

3 Module 3 B: Medicaid Application • Part B • ACCESS NY (ANY) Health Care Application (DOH 4220) • Reviews each section • Identifies various health insurance programs available through ANY

4 Overview of Presumptive Eligibility Process Pregnant woman contacts Qualified Provider completes Presumptive Eligibility Screening Checklist Does pregnant woman (PW) meet Presumptive Eligibility (PE) criteria? Yes No

5 Does PW meet PE Criteria? Yes Provider gives notice of PE to PW (PE Determination Letter) Provider helps PW complete the ACCESS NY Health Care Application if PW wants to apply for full Medicaid Coverage

6 Presumptive Eligibility Determination Letter • Official written notice of Presumptive Eligibility Determination • Informs the PW of: • Start dates for coverage, if eligible • LDSS that will process the case May be used as proof of coverage so PW can access services

7 Overview of Presumptive Eligibility Process Pregnant woman contacts Qualified Provider completes Presumptive Eligibility Screening Checklist Does pregnant woman (PW) meet Presumptive Eligibility (PE) criteria? Yes No

8 Does PW meet PE Criteria? No Give PW notice of ineligibility and refer to NYSOH END

9 Presumptive Eligibility Determination Letter, cont. • Informs the PW that she can get a more complete eligibility determination if found ineligible for PE: • At the LDSS • At the NYSOH • QP should keep copy on file

10 Ahn Woods Scenario • Married, 28 years old • Lives with her husband John and Kathryn, her daughter from her previous marriage. • Income • John’s wages ($450/wk) • Ahn’s wages ($125/wk) • Kathryn’s Child support ($50/wk)

11 Ahn Woods 15 County Drive, Mineola, NY 11501

12 X

13 X 01 15 20__

14 X 01 15 20 Nassau

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16 Mary Smith (516) 555 -1122 Mary Smith Healthy Family Clinic Mineola, NY

17 PW eligible for Ambulatory Prenatal Medicaid Services

18 Jackie Smith Case • Single, 23 yrs. Old • Lives with 2 yr. old son • Income • Wages ($300/wk) • Child Support ($50/wk)

19 Jackie Smith 123 Mockingbird Lane, Anytown, NY 11501

20 X

21 X 05 16 20__

22 X 05 16 20__ Your County

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24 Elizabeth Brown (211) 999 -3300 Elizabeth Brown Anytown Obstetrics, PPCc Anytown, NY

25 Does PW meet PE Criteria? No Give PW notice of ineligibility and refer to NYSOH END

26 If PW Is Not Presumptively Eligible QP cannot accept an application for the PW • She must submit the application to the NYSOH

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30 Confused? • Confused about the Determination and Letter? • Re-play the narrated presentation and review the Training Materials