Presumptive Eligibility Forms and Resources for Providers

Presumptive Eligibility Overview PowerPoint - A PowerPoint presentation detailing the Presumptive Eligibility program and its utility.

Presumptive Eligibility Consumer Flyer - A flyer explaining the Presumptive Eligibility program.

Presumptive Eligibility Statement of Interest - Document to be filled out by facilities looking to become Qualified Entities who can provide Presumptive Eligibility determinations for consumers.

PE Hospital MOU Example - Example of a Memorandum of Understanding contract for a hospital. Not to be filled out - only for demonstration purposes.

Presumptive Eligibility Resource Manual - A manual describing every aspect of the PE Program in detail.

PE Access and Change Request Form - A form that supervisors can fill out and send to us to either request access for a new PE worker or deactivate someone who is no longer doing PE.

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