Title of Rule:	Revisions to the Family and Children’s Medicaid Rule for Presumptive Eligibility, Section 8.101	
Rule Number:	MSB 07-09-05-A	
Division / Contact / Phone:	Program Eligibility & Implementation / Ann Clemens / (303) 866-6115	
SECRETARY OF STATE
RULES ACTION SUMMARY AND FILING INSTRUCTIONS

SUMMARY OF ACTION ON RULE(S)

1.	Department / Agency Name:	Health Care Policy and Financing / Medical Services Board	
2.	Title of Rule:	MSB 07-09-05-A, Revisions to the Family and Children’s Medicaid Rule for Presumptive Eligibility, Section 8.101	
3.	This action is an adoption of:	an amendment	
4.	Rule sections affected in this action (if existing rule, also give Code of Regulations number and page numbers affected): 	
Sections(s) 8.101.11, Colorado Department of Health Care Policy and Financing, Staff Manual Volume 8, Medical Assistance (10 CCR 2505-10).	
5.	Does this action involve any temporary or emergency rule(s)?	Yes	
If yes, state effective date:		
Is rule to be made permanent? (If yes, please attach notice of hearing).	Yes	

PUBLICATION INSTRUCTIONS*
Please replace current text at §8.101.1  MEDICAID ELIGIBILITY FOR FAMILIES AND CHILDREN through the end of  8.101.11.L with the new text provided from 8.101 through the end of 8.101.11.L effective 03/30/2008.

Title of Rule:	Revisions to the Family and Children’s Medicaid Rule for Presumptive Eligibility, Section 8.101	
Rule Number:	MSB 07-09-05-A	
Division / Contact / Phone:	Program Eligibility & Implementation / Ann Clemens / (303) 866-6115	
STATEMENT OF BASIS AND PURPOSE

1.	Summary of the basis and purpose for the rule or rule change.  (State what the rule says or does and explain why the rule or rule change is necessary).	
This revision to the Family and Children's Medicaid Rule for Presumptive Eligibility expands presumptive eligibility benefits to children under the age of 19.  This rule is in response to SB 07-211, which revised 25.5-5-204 and 25.5-5-205, C.R.S. (2006).	
2.	An emergency rule-making is imperatively necessary	
	to comply with state or federal regulation and/or	
	for the preservation of public health, safety and welfare.	
Explain:	
SB 07-211 requires the Department to add a presumptive eligibility period for children.	
3.	Federal authority for the Rule, if any:	
42 U.S.C. Section 1396r-1a 	
4.	State Authority for the Rule:	
25.5-1-301 through 25.5-1-303, C.R.S. (2006);
25.5-5-204, C.R.S. (2007)
25.5-5-205, C.R.S. (2007)	

Title of Rule:	Revisions to the Family and Children’s Medicaid Rule for Presumptive Eligibility, Section 8.101	
Rule Number:	MSB 07-09-05-A	
Division / Contact / Phone:	Program Eligibility & Implementation / Ann Clemens / (303) 866-6115	
REGULATORY ANALYSIS

1.	Describe the classes of persons who will be affected by the proposed rule, including classes that will bear the costs of the proposed rule and classes that will benefit from the proposed rule.
Children under the age of 19 will benefit from the proposed rule because they will be presumptively eligible for Medicaid and will be able to immediately access medical services while waiting for their application to be processed.
2.	To the extent practicable, describe the probable quantitative and qualitative impact of the proposed rule, economic or otherwise, upon affected classes of persons.
	The qualitative impact of the proposed rule is that children will be presumptively eligible for Medicaid.
3.	Discuss the probable costs to the Department and to any other agency of the implementation and enforcement of the proposed rule and any anticipated effect on state revenues.
The cost to implement system changes is approximately $304,204, of which $59,600 was allocated under the fiscal note in SB 07-211 and appropriated by the General Assembly.
4.	Compare the probable costs and benefits of the proposed rule to the probable costs and benefits of inaction.
The Department must implement the proposed rule pursuant to SB 07-211.
5.	Determine whether there are less costly methods or less intrusive methods for achieving the purpose of the proposed rule.
The Department has determined that there are no less costly methods or less intrusive methods available to achieve the purpose of the proposed rule.
6.	Describe any alternative methods for achieving the purpose for the proposed rule that were seriously considered by the Department and the reasons why they were rejected in favor of the proposed rule.
There are no alternative methods for achieving the purpose of the proposed rule.  The change is required by state law. 

8.101.1  MEDICAID ELIGIBILITY FOR FAMILIES AND CHILDREN
.11  Medical assistance shall be provided to families and children who meet the federal definition of categorically needy. All references to 1931 Medicaid apply to AFDC rules effective on July 16, 1996. The following are considered under this group.
A.  Persons who would have been eligible for AFDC (1931 Medicaid).
B.  Children who would be eligible for 1931 Medicaid except for the consideration of income from a stepparent outside the assistance unit, or a grandparent outside the assistance unit.
C.  Persons who would be eligible for 1931 Medicaid except for the inclusion in the assistance unit of a child/children whose income makes the unit ineligible. This also applies to parents with only one child.
D.  Persons who would be eligible for 1931 Medicaid except for the income of a child(ren) outside the assistance unit whose income makes the unit ineligible.
E.  A child born to a woman eligible for and receiving Medicaid at the time of the child's birth, is continuously eligible for one year as long as the child remains a member of the household. This applies to children born to undocumented aliens and certain legal aliens as outlined in Section 8.100.53. To receive Medicaid under this category, the family need not file an application nor provide a social security number or proof of application for a social security number for the newborn. Anyone can report the birth of the baby by telephone. Information provided shall include the baby's name, date of birth, and mother's name or Medicaid number. A newborn can be reported to the county department at any time. Once reported a newborn meeting the above criteria shall be put on Medicaid from date of birth.
F.  Children up to age six whose income does not exceed their proportionate share of 133% of the federal poverty level; or whose total family income does not exceed 133% of the federal poverty level.
G.  Children born after September 30, 1983, not 19 years of age whose income does not exceed their proportionate share of 100% of the federal poverty level; or whose total family income does not exceed 100% of the federal poverty level.
H.  If an individual is found ineligible because his/her income exceeds their proportionate share of the federal poverty level, a recalculation shall be performed to look at the Medicaid required household as a whole. The household's total income, after the allowable Medicaid deductions, shall be compared to the maximum federal poverty level. If the individual is then eligible under this process, he/she shall be coded under the same category for which they originally were determined ineligible.
I.  Medical assistance shall be provided to persons in a facility eligible for Medical reimbursement who, if they left the facility, would be eligible for 1931 Medicaid.
J.  Medical assistance shall be provided to a woman:
a.  whose pregnancy is medically verified in writing by a medical professional (a certified medial assistant or higher level position supervised by a registered nurse or doctor), if pregnancy is not observable; and
b.  whose income does not exceed her proportionate share of 133% of the federal poverty level or whose total family income does not exceed 133% of federal poverty level; and
c.  for a period beginning with the date of application for medical assistance or as of the date the person becomes eligible for medical assistance, whichever is the later calendar date, through 60 additional days from the date the pregnancy ends.
K.  Until the implementation of SB 03-176, a pregnant legal alien is eligible for state-funded prenatal medical care if she meets the eligibility requirements for expectant mothers listed in J.
L.  A pregnant applicant may apply for presumptive eligibility for ambulatory services through Medicaid presumptive eligibility sites.  [Eff  08/30/2006] A child under the age of nineteen may apply or have an adult apply on their behalf for presumptive eligibility for State Plan approved medical services through presumptive eligibility sites.
To be eligible for presumptive eligibility, an applicant shall have a verified pregnancy, declare that her household's income shall not exceed 133% of federal poverty level and declare that she is a United States citizen or a documented immigrant.  [Eff  08/30/2006]

To be eligible for presumptive eligibility, a child under the age of 19 shall have a declared household income that does not exceed 100% of federal poverty level for a child age 6-18 or 133% of federal poverty level for a child under the age of 6 and declare that the child is a United States citizen or a documented immigrant of at least five years.
Presumptive eligibility sites shall be certified by the Department of Health Care Policy and Financing to make presumptive eligibility determinations. Sites shall be re-certified by the Department of Health Care Policy and Financing every 2 years to remain approved presumptive eligibility sites.  [Eff  08/30/2006]
The presumptive eligibility sites shall attempt to obtain all necessary documentation to complete the application within fourteen calendar days of application. [Eff  08/30/2006]
The presumptive eligibility site shall forward the application to the county within five business days of being completed. If the application is not completed within fourteen calendar days, on the fifteenth calendar day following application, the presumptive eligibility sites shall forward the application to the appropriate county.  [Eff  08/30/2006]
The presumptive eligibility period shall be no less than 45 days.  The presumptive eligibility period ends on the last day of the month following the completion of the 45 day Presumptive Eligibility period.  The county department shall make a Medicaid eligibility determination within 45 days from receipt of  the application. The effective date of Medicaid eligibility shall be the date of application.  [Eff  08/30/2006]
A Presumptive eligible  client may not appeal the end of a presumptive eligibility period.  [Eff  08/30/2006]