Hospital Presumptive Eligibility 

Hospital Presumptive Eligibility 

The Office for Family Independence (OFI) has proposed changes to Hospital Presumptive Eligibility (HPE) rules, which authorizes hospitals in the State of Maine to make limited MaineCare eligibility determinations for certain individuals.  

Specifically, it spells out the conditions to be become a qualified provider for presumptive eligibility, the process for making such a determination, the duration of the presumptive decision, and the process for assisting applicants in securing ongoing eligibility.  The entire proposed rule is available at https://www.maine.gov/dhhs/ofi/about-us/rules/proposed.

Hospitals interested in making presumptive eligibility determinations must become qualified providers or renew their previous HPE agreement with OFI.  To do so, the following requirements must be met:

• Be enrolled and participating as a MaineCare provider through the Office of MaineCare Services;
• Sign and comply with an agreement to make presumptive eligibility determinations consistent with state policy and procedures;
• Accept training for all applicable hospital staff on relevant MaineCare eligibility rules and regulations; and
• Meet established quality standards as set forth in the MaineCare Eligibility Manual, Part 18: Hospital Presumptive Eligibility

A comprehensive online training program has been developed for providers who wish to enroll.  Each hospital employee who will be making HPE determinations must complete this training program and pass a knowledge test prior to any determinations being made.  To become a Hospital Presumptive Eligibility provider, please send the following information to us at PE.DHHS@maine.gov:

• Hospital Name
• Approximate number of staff who will complete training
• Primary Contact Name
• Primary Contact Email Address and Phone Number 

Once OFI receives notice of intention to become a qualified provider, additional information will be provided.  We look forward to working with you to support MaineCare eligibility needs for the people of Maine.