Catch up day 14- Medicaid at 50: Presumptive Eligibility

Ok guys- this is literally my favorite provision of Medicaid.

The Affordable Care Act gave hospitals in states the option to do presumptive eligibility. This basically means, that a hospital could treat a person under the presumption that they are eligible for Medicaid rather than waiting until the state processes their application. But get this– it doesn’t matter if the hospital is in an expansion state or not. Obviously, the state has to abide by the Medicaid law in the state– not pretending that they live in an expansion state.

Why is it my favorite provision? I just loved working on stories like these. So fascinating!

I’m gonna quote myself or old times sake.

Federal Medicaid spokeswoman Emma Sandoe explained that the rule doesn’t actually open the doors to Medicaid expansion.

“There’s a long-running statute in Medicaid that a state can do what’s called presumptive eligibility – that means, if someone is presumed to be eligible, they can enroll,” Sandoe said. “Originally, it was for women and children. In July, we released a regulation that extends this to newly eligible people under the Affordable Care Act. It also says hospitals can make that determination.”

However, Sandoe pointed out, the rule explicitly says that presumptive eligibility must follow each state’s eligibility criteria.

“States’ eligibility rules govern this,” she explained, “and hospitals aren’t required to do it.”


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