17-01 Version of 32.3 Qualified Hospitals

For the purposes of presumptive eligibility, a hospital is defined as an inpatient hospital facility or an outpatient hospital facility located within the four walls of an inpatient hospital facility, consistent with the definition of hospital for the purpose of billing Medicaid. These facilities are enrolled in Wisconsin Medicaid as Provider Type 01 or Provider Type 58.

Qualified hospitals are certified by ForwardHealth to make presumptive eligibility determinations. Qualified hospitals can make presumptive eligibility determinations for the following populations:

• Children
• Pregnant women
• People applying for Family Planning Only Services (see Section 40.2 Presumptive Eligibility)
• Parents and caretakers
• Childless adults
• Women under age 65 with breast or cervical cancer (see the Medicaid Eligibility Handbook, Section 36.2.2.1 Temporary Enrollment/Presumptive Eligibility Available Only To Women Enrolling Through WWWP)
• Inmates of public correctional institutions (see Section 32.2.3.5 Inmates)

Hospitals are required to notify ForwardHealth of their interest in becoming a qualified hospital for presumptive eligibility via the ForwardHealth Portal.

Only qualified hospital staff can make presumptive eligibility determinations at qualified hospital locations. Third-party contractors are not allowed to make presumptive eligibility determinations for a qualified hospital, though they can assist an applicant with completing the application for ongoing coverage.

Qualified hospitals are subject to standards on assisting the patient with also submitting an application for ongoing health care coverage. For patients eligible for temporary enrollment in BadgerCare Plus or Family Planning Only Services, qualified hospitals are subject to standards on assisting the patient with submitting an application for ongoing BadgerCare Plus or Family Planning Only Services coverage.

This page last updated in Release Number: 17-01
Release Date: 04/11/2017
Effective Date: 09/24/2016