Tuesday, January 20, 2015

Can't Tell If He's Eligible? Presume He Is

Waiting may well be the hardest part in applying for Medicaid. With millions of applications flooding agencies' desks, many are stuck in limbo, delaying adequate care in some cases. Prolonged waiting time also affects the operations of medical providers, particularly in the financial department. The answer to this dilemma could be presumptive eligibility (PE).

As the term implies, PE provides an uninsured patient Medicaid benefits even before he gets officially qualified, as long as his basic information checks out. In return, the patient receives part of the Medicaid package and only gets the rest upon providing additional data. In the meantime, the medical facility can get paid through Medicaid benefits.

If the patient files for a full application within a month of PE determination, the PE will last for as long as a thorough Medicaid assessment takes. Patients ineligible for Medicaid, as determined in the PE process, may be referred by the hospital to a single, streamlined application (SSA). Meanwhile, those who were determined to be eligible for Medicaid during the PE process may also be referred to the single, streamlined application (SSA), if they were eventually found to be ineligible, or wish to apply for coverage through the health insurance marketplace, instead.

The SSA integrates various forms used by federal health programs several years ago. The application is designed like a questionnaire, which helps make choices much clearer for the applicant. It's also arranged in step-by-step segments so that applicants can be guided properly. 

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