Qualified Provider Application Agreement

Federal Poverty Level for Presumptive Eligibility as of 4/1/13

Presumptive Eligibility, Emergency Services, Pregnant Woman Matrix 

Presumptive Eligibility Fact Sheet

Presumptive Eligibility Providers' Manual

Presumptive Eligibility for Qualified Providers

Presumptive Eligibility Intake Form

Presumptive Eligibility Calculation Form

Presumptive Eligibility Rights and Responsibilities Form

Presumptive Eligibility Approval Notice

Presumptive Eligibility Denial Notice

Healthcare Coverage Application

Healthcare Coverage Application SPANISH