1314 Hospital Presumptive Eligibility (HPE) Application Process

Revised 04/01/2025

Policy

This section describes application requirements that are specific to the HPE program. 

General information about the application process can be found in MA1301 and MA1302. 

1) HPE applications:

A HPE application is a shorter streamlined version of a full AHCCCS Medical Assistance application containing questions only about the following:

• Contact Information;

• Authorized Representative; (if applicable)

• Personal Information; (for all members of the household)

• Citizenship/Residency;

• Pregnancy Information;

• Foster Care Information;

• Employment Information;

• Other Income Information;

• Medicare Information;

• Parent or Caretaker Relative Information

• Application signature.

 

Unlike other programs, the customer does not need to provide proof of any these factors to qualify for HPE. However, the customer can only qualify for HPE once every 24 months;

NOTE     HPE applications may ONLY be completed by hospital employees or vendors contracted with a hospital that have signed an agreement with AHCCCS to process HPE applications.

 

2) Who can be approved for HPE?

Only a person who is not currently receiving Medicaid, has not had HPE eligibility in the past 24 months, and qualifies for one of the following categories may be approved for HPE:

• Pregnant Woman (MA410)

• Child (MA406)

• Caretaker Relative (MA405)

• Adult (MA401)

• Young Adult Transitional Insurance (MA416)

• Breast and Cervical Cancer Treatment Program (MA404)

 

3) What is the HPE Period?

The HPE period is a temporary approval period that begins on the date the HPE is approved and continues until the earlier of the following:

• The last day of the month after the month the HPE is approved, if a full Medicaid application is not submitted by this date.

• The date a decision is made on a full Medicaid application when the application is submitted by the last day of the HPE period.

HPE Period examples can be found at MAE1314. 

In order for the customer to have eligibility continued beyond the HPE period the customer must complete and submit a full Medicaid application before the end of the HPE period and be found eligible for Medicaid. 

 

4) Who decides HPE eligibility and notifies the customer?

Only qualified hospital staff from Subscriber Organizations determine HPE. This is done by using a shorter streamlined version of the full application in HEAplus and issuing a HPE decision notice.

AHCCCS and DES staff do not make decisions for the HPE program or send decision letters to customers.

 

Definitions

Term	Definition
Hospital Presumptive Eligibility (HPE)	Temporary coverage for people who are likely to qualify for AHCCCS Medical Assistance. See MA417 for details. NOTE     Eligibility for HPE is determined by qualified hospitals
Qualified hospital	A hospital that has agreed to follow the state’s HPE policies and procedures.

 

Legal Authority

Program	Legal Authorities
Hospital Presumptive Eligibility (HPE)	AAC R9-22-1601