Policy History for 5.15.2 Presumptive Eligibility (PE)

Release 07-08

5.15.2 Presumptive Eligibility (PE)

FPW presumptive eligibility ( PE ) provides family planning services beginning on the day that a qualified provider determines that the woman is/has:

  1. 15 years of age or older and under age 45, and

  2. Wisconsin resident, and

  3. A citizen of the U.S., and

    The qualified provider should refer non-citizens to the IM Agency for a MA eligibility determination.   

  4. Income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. at or below 185% of the Federal Poverty Level ( FPL ),and  

  5. Not receiving a full-benefit MA subprogram (7.1.2)

FPW PE extends from the date that the woman is determined eligible by the qualified provider through two calendar months following the month of application.  FPW PE can only be received once within a 12-month period.

Note:  The FPW PE period extends one full calendar month longer than the PE period for pregnant women (5.2.4).

5.15.2.1 Qualified Providers

Qualified providers are certified by the Division of Health Care Financing ( DHCF ).  A qualified provider will determine if a woman is presumptively eligible for the FPW.  If she is found to be eligible, the qualified provider will:

  1. Complete and sign the Medicaid Family Planning Waiver Presumptive Eligibility Application form ( HCF 10119 ).
     

  2. Fill out the temporary MA ID card at the bottom of the HCF 10119.  The certification dates will be from the date FPW PE is determined through the end of the second month following the month in which the determination is made.
     

  3. Give the woman the temporary MA ID card.
     

  4. Explain that the duration of her FPW PE period depends on when she applies for MA and the ongoing FPW through her local IM agency.

 

  1. If she applies for ongoing FPW by the end of the second month following the month in which she became eligible for FPW PE, the ongoing FPW period begins the first of the month in which she applied and is found eligible.  The FPW PE period ends the day before her ongoing FPW period is to begin.
     

    Example 1:  Amber applies for FPW PE on September 19th.  Her FPW PE will continue through the end of November.

     

    Amber applies for ongoing FPW on November 2nd and is found eligible.  Amber’s ongoing FPW will begin November 1st, and her FPW PE will end October 31st.

  1. If she does not apply by the end of the second month following the month in which she became eligible for FPW PE, the FPW PE period ends the last day of the second month following the month in which she was determined eligible for FPW PE.

     

    Example 2:  Brenda applied for FPW PE on April 3rd.  Her FPW PE continued through the end of June.

    Amber does not apply for ongoing FPW until August 15th and is found eligible beginning August 1st. Brenda’s FPW PE ended June 30th.

  1. Send a copy of the completed HCF 10119 to the MA fiscal agent and the IM Agency within five days of completion.

5.15.2.2 At the IM Agency

If the woman applies for MA and/or ongoing FPW at the IM Agency on or before the last day of her FPW PE period:

  1. Verify she is presumptively eligible by checking her temporary MA ID card or checking MMIS for a medical status code of “PF”.

  2. Assist her in filing the application.  Consider the application filed if her name, address and signature are on the application.

  3. If you are unable to finish processing her application by the end of her FPW PE period, submit a HCF 10110 ( formerly DES 3070 ) to extend her FPW PE period for an additional calendar month.

This page last updated in Release Number: 03-02

Release Date: 04/01/03

Effective Date: 04/01/03