Issue Briefs | Nov 1, 2013

Implementation of the Affordable Care Act’s Hospital Presumptive Eligibility Option: Considerations for States

Center for Health Care Strategies – Shannon McMahon, Maia Crawford and Christian Heiss

The Affordable Care Act (ACA) gives qualified hospitals the opportunity to determine presumptive eligibility (PE) for all Medicaid-eligible populations which will enable hospitals to temporarily enroll individuals in Medicaid, ensuring compensation for hospital-based services, while providing patients access to medical care and a pathway to longer-term Medicaid coverage.  This brief, prepared by the Center for Health Care Strategies, provides guidance to aid state Medicaid programs in developing the policies and procedures for hospital PE implementation.  It provides valuable insight from the final CMS rule, related CMS guidance, expert sources, and interviews with states currently operating PE programs. The brief organizes information on hospital PE under four topics: (1) qualified provider requirements; (2) training and certification; (3) performance standards; and (4) plan enrollment and payment.