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Presumptive Eligibility: A Step toward Streamlined Enrollment in Medicaid and CHIP

By Cheryl Fish-Parcham,


The Affordable Care Act expands states’ ability to use presumptive eligibility to streamline enrollment in Medicaid and CHIP (the Children’s Health Insurance Program). Presumptive eligibility gives uninsured people immediate, temporary Medicaid if they appear to be eligible based on income. This helps people get health care right away and ensures that doctors and hospitals are reimbursed for that care.

After someone is deemed “presumptively eligible,” the state performs the full eligibility process. Starting in 2014, hospitals can use presumptive eligibility to enroll uninsured patients in Medicaid.

Advocates and state policy makers can use this brief to find out what steps they should take to ensure that presumptive eligibility is a part of enrollment in 2014.