In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.
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.