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CMS Releases Informational Bulletin on Presumptive Eligibility

Thursday, January 30, 2014

The Centers for Medicare and Medicaid Services recently released an informational bulletin providing guidance for states on the implementation of presumptive eligibility (PE). Under the Affordable Care Act (ACA), states are now required to implement hospital PE policies. PE allows certain qualified providers to make a preliminary eligibility determination for Medicaid or CHIP based on an individual's income, before a full application has been submitted, which increases access to health services. While PE has been an option for pregnant women and children, the ACA has extended it to all individuals who meet state Medicaid eligibility requirements.

The bulletin, entitled Medicaid and CHIP FAQs: Implementing Hospital Presumptive Eligibility, provides information for states on implementation of PE. Topics include application processing, eligible populations, qualified entities, qualification standards, and federal matching funds.

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