May a hospital require an uninsured patient to apply for Medicaid before it accepts an application for free care?
5101:3-2-07.17 (6) states: “Nothing in this rule shall be construed to prevent a hospital from requiring an individual to apply for eligibility under the medical assistance program before the hospital processes an application under this rule.” However, the statement only permits a hospital, if it wishes, to require a patient to apply for Medicaid prior to its processing an application. Once the patient applies, the application should be processed as normal and, if the patient is eligible for HCAP, the covered charges written off to HCAP. If the patient is later found to be eligible for Medicaid, the HCAP write-off should be reversed–assuming the applicable cost report is still open–and the account billed to Medicaid.
5101:3-2-07.17(B)(7) permits a hospital to require a patient to apply for Medicaid prior to processing an application for free care. Once the patient applies for Medicaid, the free care application should be processed as normal and, if the patient is eligible for free care, the covered charges should be written off to HCAP. If the patient is later found to be eligible for Medicaid, the HCAP write-off should be reversed and the account billed to Medicaid, assuming the applicable cost report is still open. However, if a retroactive Medicaid eligibility determination occurs after the Medicaid Cost Report for the period that covers the date of service or admission is closed, no reversal of the HCAP write-off is possible and the hospital may still bill Medicaid for the covered services. This FAQ does not apply to write-offs for patients with incomes above the federal poverty income guidelines (see FAQ 7.2b for additional information). (07/01/10) FAQs 2.4a & b were moved to the section on Pa
Related Questions
- Occasionally a Medicaid managed care patient will go to an out-of-panel hospital for elective care. If the out-of-panel hospital puts the patient on notice that (s)he will be responsible for the charges, as required by OAC 5101:3-26-11, can the patient later apply for HCAP?
- May a hospital require an uninsured patient to apply for Medicaid before it accepts an application for free care?
- What does Georgia Medicaid require to qualify a patient for Oxygen?
