42 CFR §436.1102
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
- (a)The agency may provide services to children under age 19 during one or more periods of presumptive eligibility following a determination made by a qualified entity that the child's estimated gross family income or, at the State's option, the child's estimated family income after applying simple disregards, does not exceed the applicable income standard.
- (b)If the agency elects to provide services to children during a period of presumptive eligibility, the agency must—
- (1)Provide qualified entities with application forms for Medicaid and information on how to assist parents, caretakers and other persons in completing and filing such forms;
- (2)Establish procedures to ensure that qualified entities—
- (i)Notify the parent or caretaker of the child at the time a determination regarding presumptive eligibility is made, in writing and orally if appropriate, of such determination;
- (ii)Provide the parent or caretaker of the child with a Medicaid application form;
- (iii)Within 5 working days after the date that the determination is made, notify the agency that a child is presumptively eligible;
- (iv)For children determined to be presumptively eligible, notify the child's parent or caretaker at the time the determination is made, in writing and orally if appropriate, that—
- (A)If a Medicaid application on behalf of the child is not filed by the last day of the following month, the child's presumptive eligibility will end on that last day; and
- (B)If a Medicaid application on behalf of the child is filed by the last day of the following month, the child's presumptive eligibility will end on the day that a decision is made on the Medicaid application; and
- (v)For children determined not to be presumptively eligible, notify the child's parent or caretaker at the time the determination is made, in writing and orally if appropriate—
- (3)Provide all services covered under the plan, including EPSDT.
- (4)Allow determinations of presumptive eligibility to be made by qualified entities on a Statewide basis.
- (c)The agency must adopt reasonable standards regarding the number of periods of presumptive eligibility that will be authorized for a child in a given time frame.