Presumptive Eligibility for Medicaid Patients

What if someone in your family needs immediate medical care and your healthcare insurance application is still pending? There’s still a way that your loved one can benefit from quality Medicaid or CHIP services even though his or her application for healthcare insurance hasn’t yet been fully processed. This is possible through presumptive eligibility, a policy option that was implemented beginning of last year.

Defining Presumptive Eligibility

Presumptive eligibility allows qualified individuals, including children and their parents, pregnant women, and adults, to make temporary eligibility decisions on the spot, based on an assessment of their gross family income. Through presumptive eligibility, qualified individuals whose application is still underway are allowed to be given immediate access to medical services, thus preventing any serious health complications from developing, and saving future high costs of medical care.

In the past, presumptive eligibility was only available to children and pregnant women. After the implementation of the Affordable Care Act, however, states adopting presumptive eligibility are now able to provide the service to parents and adults covered by Medicaid.

States with Presumptive Eligibility

So far, 32 states have adopted presumptive eligibility as a policy option for pregnant women, while 15 states have adopted this for children in both Medicaid and CHIP. Hospitals, however, can choose to adopt presumptive eligibility, regardless of whether their state has adopted this policy or not.