Hospital Presumptive Eligibility

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The Hospital Presumptive Eligibility (HPE) program allows participating hospitals to determine eligibility for Medical Assistance (MA) for people who meet the basic criteria. Minnesota hospitals that choose to participate may begin making eligibility determinations for Hospital Presumptive Eligibility (HPE) starting July 1, 2014.

  • • Under the HPE regulations, hospitals can temporarily enroll patients in MA with a few basic pieces of information such as income and household size. Qualified hospitals must submit approved HPE applications to DHS within five business days of the date of approval.
  • • Presumptive eligibility not only helps people get needed health coverage but also helps hospitals receive payment for services they provide before the person completes a full application for MA.
  • • The HPE period lasts until the individual receives an eligibility determination for ongoing MA or until the last day of the month following the month in which HPE was determined, whichever comes first.
  • • Individuals are limited to one HPE period every 12 months.
  • • Women who become pregnant can have one HPE period during each pregnancy.
  • • Individuals receive regular MA services during the HPE period.

  • Participation in Presumptive Eligibility

    Hospitals may choose to participate in HPE by completing the Hospital Presumptive Eligibility Applicant Assurance Statement DHS-3887 (PDF) addendum to their provider agreement and having staff participate in required training. HPE helps people get needed health care coverage and helps hospitals receive payments for services they provide before a full MA determination is made.

    Qualified Hospitals

    To be a qualified hospital, the hospital must:

  • • Be enrolled as a provider with Minnesota Health Care Programs (MHCP) and complete the Hospital Presumptive Eligibility Applicant Assurance Statement DHS-3887 (PDF).
  • • Participate in required training. Hospitals will need to submit the names and HPE Learning Center identification number of a minimum of two hospital staff 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 Insurance Affordability Programs application or offer them information on other help available, such as through a navigator.
  • • Meet established performance standards.
  • • 80% of the people approved for HPE by the hospital must submit a complete IAP application within 30 days of the end of the HPE coverage period.
  • • 80% of the people who file an IAP application are determined eligible for MA.
  • HPE Training

    An online training course is available for hospital staff who will be making MA determinations for HPE. Staff who will be taking the training will need a Unique Key to access the training course. To request a Unique Key and to register for the training, refer to the HPE Training page.

    Eligibility Determinations

    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.
  • HPE Eligibility

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

  • • Pregnant women
  • • Children under age 21
  • • Parents and caretakers
  • • Adults without children (between the ages of 19-64)
  • • People under age 26 who were in foster care at age 18 (no income limit)
  • HPE 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 IAP application
  • • The last day of the month following the month in which the person is approved for HPE

  • Additional Resources
    Section 2202 of the Affordable Care Act (ACA) and Sec. 1902(a)(47) of the Social Security Act

    42 CFR 435.1101-1103 and 1110

    Minn. Stat. §256B.057, Subd. 12

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