{"data":{"id":"us-ky/krs-205.5375","jurisdiction":"us-ky","citation":"KRS 205.5375","heading":"Definitions for section -- Presumptive eligibility -- Determination --","body":"Requirements -- Administrative regulations.\n(1) As used in this section:\n(a) \"Department\" means the Department for Medicaid Services;\n(b) \"Period of presumptive eligibili ty\" has the same meaning as in 42 C.F.R. sec.\n435.1101; and\n(c) \"Qualified hospital\" has the same meaning as in 42 C.F.R. 435.1110(b).\n(2) If a qualified hospital determines that an individual meets the criteria for\npresumptive eligibility using information provided and attested to by the individual,\nthe hospital shall:\n(a) Notify the department of the determination within five (5) business days from\nthe date of determination in a form prescribed by the department;\n(b) Provide a written eligibility notice t o the individual. The written eligibility\nnotice shall, at a minimum, include the following information in plain\nlanguage and large print:\n1. The beginning and end dates of the period of presumptive eligibility;\n2. Notification that the individual is required to make an application for\nMedicaid benefits through the individual's local Department for\nCommunity Based Services office;\n3. The location of the individual's local Department for Community Based\nServices office;\n4. Notification that if the individual does not file a full Medicaid\napplication before the last day of the following month, the period of\npresumptive eligibility coverage will end on that day; and\n5. Notification that if the individual does file a full  Medicaid application\nbefore the last day of the following month, presumptive eligibility\ncoverage will continue until an eligibility determination is made on the\napplication by the department;\n(c) Issue a presumptive eligibility identification card or doc ument to the\npresumed eligible individual;\n(d) Maintain a record of the presumptive eligibility screening for each\napplication; and\n(e) Assist presumptively eligible individuals in completing and submitting a full\nMedicaid application prior to the end of the period of presumptive eligibility.\n(3) If a qualified hospital determines that an individual does not meet the criteria for\npresumptive eligibility using information provided and attested to by the individual,\nthe hospital shall provide the individual with written notification of:\n(a) The reason for the determination;\n(b) Notification that the individual may file a full Medicaid application through\nthe individual's local Department for Community Based Services office if the\nindividual wishes to have a fo rmal determination of eligibility made by the\ndepartment; and\n(c) The location of the individual's local Department for Community Based\nServices office.\n(4) Notwithstanding any other provision of law to the contrary and to the extent\npermitted under federal law, a pregnant individual shall be limited to one (1) period\nof presumptive eligibility per pregnancy.\n(5) (a) The department shall provide training on all applicable state and federal laws\nrelated to presumptive eligibility to all qualified hospitals.\n(b) Prior to conducting presumptive eligibility screenings and determinations, a\nqualified hospital's staff, contractor, or vendor responsible for presumptive\neligibility screenings and determinations shall be required to complete\npresumptive eligibility training provided by the department.\n(6) If a qualified hospital uses a contractor or other vendor for the purpose of\nconducting presumptive eligibility screenings and determinations, the hospital shall\nbe responsible for monitoring the contractor's or vend or's compliance with all\napplicable state and federal laws related to presumptive eligibility.\n(7) The department shall promulgate administrative regulations in accordance with\nKRS Chapter 13A that are necessary to administer this section. Administrative\nregulations promulgated pursuant to this subsection shall include but not be limited\nto a thorough presumptive eligibility application form to be used by qualified\nhospitals when making presumptive eligibility determinations using information\nprovided and attested to by an individual.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=57028","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"afef0892c3adbb9eab4312c3abe3f7427f0f7e149d0006bc35572a37740b07ef","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.5374","next":"us-ky/krs-205.5376"},"notice":"GroundRules: Original legal text. Not legal advice."}