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U.S. Code as of:
01/19/04
Section 1396r-1a. Presumptive eligibility for children
(a) In general
A State plan approved under section 1396a of this title may
provide for making medical assistance with respect to health care
items and services covered under the State plan available to a
child during a presumptive eligibility period.
(b) Definitions; regulations
For purposes of this section:
(1) The term "child" means an individual under 19 years of age.
(2) The term "presumptive eligibility period" means, with
respect to a child, the period that -
(A) begins with the date on which a qualified entity
determines, on the basis of preliminary information, that the
family income of the child does not exceed the applicable
income level of eligibility under the State plan, and
(B) ends with (and includes) the earlier of -
(i) the day on which a determination is made with respect
to the eligibility of the child for medical assistance under
the State plan, or
(ii) in the case of a child on whose behalf an application
is not filed by the last day of the month following the month
during which the entity makes the determination referred to
in subparagraph (A), such last day.
(3)(A) Subject to subparagraph (B), the term "qualified entity"
means any entity that -
(i)(I) is eligible for payments under a State plan approved
under this subchapter and provides items and services described
in subsection (a) of this section, (II) is authorized to
determine eligibility of a child to participate in a Head Start
program under the Head Start Act (42 U.S.C. 9831 et seq.),
eligibility of a child to receive child care services for which
financial assistance is provided under the Child Care and
Development Block Grant Act of 1990 (42 U.S.C. 9858 et seq.),
eligibility of an infant or child to receive assistance under
the special supplemental nutrition program for women, infants,
and children (WIC) under section 1786 of this title )1(!
eligibility of a child for medical assistance under the State
plan under this subchapter, or eligibility of a child for child
health assistance under the program funded under subchapter XXI
of this chapter, (III) is an elementary school or secondary
school, as such terms are defined in section 8801 of title
20,)2(! an elementary or secondary school operated or supported
by the Bureau of Indian Affairs, a State or tribal child
support enforcement agency, an organization that is providing
emergency food and shelter under a grant under the Stewart B.
McKinney Homeless Assistance Act )2(! [42 U.S.C. 11301 et
seq.], or a State or tribal office or entity involved in
enrollment in the program under this subchapter, under part A
of subchapter IV of this chapter, under subchapter XXI of this
chapter, or that determines eligibility for any assistance or
benefits provided under any program of public or assisted
housing that receives Federal funds, including the program
under section 8 [42 U.S.C. 1437f] or any other section of the
United States Housing Act of 1937 (42 U.S.C. 1437 et seq.) or
under the Native American Housing Assistance and
Self-Determination Act of 1996 (25 U.S.C. 4101 et seq.), or
(IV) any other entity the State so deems, as approved by the
Secretary; and
(ii) is determined by the State agency to be capable of
making determinations of the type described in paragraph (2).
(B) The Secretary may issue regulations further limiting those
entities that may become qualified entities in order to prevent
fraud and abuse and for other reasons.
(C) Nothing in this section shall be construed as preventing a
State from limiting the classes of entities that may become
qualified entities, consistent with any limitations imposed under
subparagraph (B).
(c) Application for medical assistance; procedure upon
determination of presumptive eligibility
(1) The State agency shall provide qualified entities with -
(A) such forms as are necessary for an application to be made
on behalf of a child for medical assistance under the State plan,
and
(B) information on how to assist parents, guardians, and other
persons in completing and filing such forms.
(2) A qualified entity that determines under subsection (b)(2) of
this section that a child is presumptively eligible for medical
assistance under a State plan shall -
(A) notify the State agency of the determination within 5
working days after the date on which determination is made, and
(B) inform the parent or custodian of the child at the time the
determination is made that an application for medical assistance
under the State plan is required to be made by not later than the
last day of the month following the month during which the
determination is made.
(3) In the case of a child who is determined by a qualified
entity to be presumptively eligible for medical assistance under a
State plan, the parent, guardian, or other person shall make
application on behalf of the child for medical assistance under
such plan by not later than the last day of the month following the
month during which the determination is made, which application may
be the application used for the receipt of medical assistance by
individuals described in section 1396a(l)(1) of this title.
(d) Treatment of medical assistance
Notwithstanding any other provision of this subchapter, medical
assistance for items and services described in subsection (a) of
this section that -
(1) are furnished to a child -
(A) during a presumptive eligibility period,
(B) by an entity that is eligible for payments under the
State plan; and
(2) are included in the care and services covered by a State
plan;
shall be treated as medical assistance provided by such plan for
purposes of section 1396b of this title.
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