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The following questions and answers provide further details about the Hospital Presumptive Eligibility (HPE) program. Providers also should refer to the HPE Policy Guide (DHS-7267) (PDF) and HPE Procedures Guide (DHS-7267A) (PDF).
Hospital Presumptive Eligibility (HPE) permits hospitals to determine eligibility for temporary Medical Assistance (MA) for individuals based on preliminary information these applicants provide.
To qualify for HPE a person must:
No. Inmates residing in a correctional facility in Minnesota are only eligible for inpatient hospital services under MA. DHS developed a dedicated application process for inmate coverage. This process has been communicated to the Minnesota Department of Corrections and county detention facilities.
No. Any person who belongs to one of the HPE eligibility groups can apply for HPE. However, a person is eligible to receive HPE only once in a 12-month period (or once during current pregnancy). Advise individuals seeking ongoing coverage to complete the full Medical Assistance (MA) application. Individuals can complete the full MA application online at www.mnsure.org or file a paper Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF).
HPE coverage begins on the day that the qualified hospital approves a person for HPE.
HPE coverage ends:
For more information on HPE coverage begin and end dates refer to the HPE Policy Guide (DHS-7267) (PDF).
A person who is approved for HPE is eligible to receive the full MA for adults and families with children benefit set. For more information about covered services, refer to the Summary of Coverage, Cost Sharing and Limits (DHS-3860) (PDF) or the MHCP Provider Manual and the MHCP Member Evidence of Coverage.
To be approved to make HPE determinations, a hospital must: (1) be an enrolled MHCP provider; and (2) agree to comply with DHS HPE policy and procedures. Hospitals must sign and submit HPE Applicant Assurance Statement (DHS-3887) (PDF). Hospitals must also submit to DHS the names of two members of the hospital’s staff who have passed the DHS HPE training using the Hospital Staff Who Passed DHS Hospital Presumptive Eligibility Online Training Course (DHS-3889) (PDF).
Yes. HPE began in Minnesota on July 1, 2014. Hospital participation in HPE is optional. A hospital may choose to become a qualified HPE provider at any time.
A qualified HPE hospital must:
HPE hospital providers must show:
Enrollment is done on a hospital by hospital basis. Each hospital that is approved as a qualified HPE provider must demonstrate that a minimum of two hospital staff members have successfully passed the DHS HPE training.
Hospital-based clinics are enrolled with the hospital as one entity. List hospital staff members working in a hospital-based outpatient clinic under the hospital’s name and NPI.
Each hospital must have a minimum of two staff members who have passed the DHS HPE online training curriculum. Hospitals may choose to have more than two staff members who have completed the DHS HPE training. The DHS HPE online training curriculum will be available to as many hospital staff who want to take the training.
Hospitals that seek to participate in HPE must accept HPE applications from individuals during all hours of operation. Under Sec. 1920(c)(2)(A) of the SSA, hospitals must notify the state Medicaid agency within five business days of the date they approve HPE. DHS will accept all HPE applications that a hospital submits within five business days of when they approved the HPE.
Ideally, hospitals will submit approved HPE applications immediately. This speeds up the process of getting the HPE coverage span entered into MMIS and allows all MHCP providers to verify HPE coverage in MN–ITS or EVS. However, within this five-day window, hospitals have the option of using HPE trained staff to review the HPE application and make the HPE determination.
No. Hospitals are not allowed to delegate the HPE determination to third-party contractors. However, hospitals may use third-party contractors (or other non-hospital staff) to staff its HPE operations, including to help people complete the HPE application.
No, there is no limit. Each hospital is required to have a minimum of two hospital staff members who have passed the DHS HPE training for the hospital to be qualified to make HPE determinations. However, hospitals are allowed to register as many staff as they would like in the DHS Learning Center to take the HPE training.
Yes, a hospital staff person who has passed the DHS HPE online training course would be able to approve HPE for Hospital A and Hospital B. However, that staff person cannot count as one of the two unique staff to meet the minimum for either hospital.
To become qualified HPE providers, hospitals must submit the name and HPE Learning Center I.D. numbers of at least two hospital staff members using the Hospital staff who passed DHS Hospital Presumptive Eligibility online training course (DHS-3889) (PDF). DHS will not approve hospitals as HPE hospital providers who list the same two staff members on the HPE addendum. Hospitals that choose to participate as HPE hospital providers should have staffing adequate to ensure that all patients are able to file an HPE application during all hours of operation.
Detailed information and instructions on how to make the HPE determination can be found in the HPE Procedures Guide (DHS-7267A) (PDF) and the HPE Policy Guide (DHS-7267) (PDF). The Income and Household Size Worksheet (DHS-3884A) (PDF) and the Citizenship and Immigration Status Information Sheet (DHS-7267B) (PDF) are also available for reference.
The only current coverage that would be a barrier to HPE is Medical Assistance or MinnesotaCare. Other coverage is not a barrier to HPE.
No. HPE is available to only those individuals who belong to one of the following eligibility groups:
Adults without children who are enrolled in Medicare cannot receive HPE. Other individuals such as parents and caretaker relatives, pregnant women, or children ages 19 and 20 who are on Medicare can receive HPE.
For example, a grandmother (age 70 and receiving Medicare) who lives with her 7-year-old grandchild, and assumes primary responsibility for her grandchild, could have a basis of eligibility as a caretaker relative. This person would be eligible for HPE under the parent/caretaker relative basis of eligibility.
If a person is ineligible for HPE due to current enrollment in Medicare, the hospital should advise that person to complete the full application online at www.mnsure.org or the paper Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF). They should also advise the person to contact the county or tribal agency to determine if he or she is eligible for other programs.
A person must be in one of the following eligibility groups to qualify for HPE:
Refer a person who does not meet one of the above bases of eligibility to a navigator, certified application counselor, or his or her county agency to see if he or she qualifies for MA or other Insurance Affordability Programs.
No. A spenddown is an option where people who are over the income limit for Medical Assistance (MA) can apply the cost of their medical care to spend down to MA eligibility. The person must complete the full application online at www.mnsure.org or the paper Application for Health Coverage and Help Paying Costs (DHS-6696) (PDF) to be considered for MA with a spenddown.
No, Minnesota has elected to compute households for HPE based on the Modified Adjusted Gross Income (MAGI) non-filer household composition rules. For more information on how to calculate an applicant’s HPE household size, refer to the HPE Procedures Guide (DHS-7267A) (PDF).
Yes. Determinations can be made at any time. However, hospitals must submit the approved application to DHS within five business days from the date of HPE approval. For more information on submitting an application after approval, see HPE Procedures Guide (DHS-7267A) (PDF).
During business hours, hospital staff can call Health Care Eligibility Operations (HCEO) at 651-431-3480 or 888-702-9968 (select Option 1).
HCEO can provide the following information:
Yes. The information contained in the Notice of Privacy Rights is designed to ensure that HPE applicants know their rights and responsibilities.
Yes. The HPE Approval Notice serves as proof of coverage for the consumer until he or she receives the MHCP ID card in the mail. To preserve the integrity of the approval notice, DHS requires qualified HPE providers to print all HPE approvals on security paper.
Upon initial approval of your hospital as an HPE provider, DHS will provide security paper to the hospital address provided on the HPE Applicant Assurance Statement (DHS-3887) (PDF).
To request additional security paper, call the HPE phone line at 651-431-3480 or 888-702-9968 and press option 1. Allow 14 days from the time of the request for delivery.
Hospitals are responsible for securing the DHS watermark paper to prevent any misuse.
Yes. Submit claims for services provided to recipients of HPE exactly as any other MHCP fee-for-service (FFS) program. Claims processing data will be on the same remittance advice as all other FFS claims. Reimbursement will be included in the FFS EFT or check warrant.
