On January 24, CMS issued a bulletin announcing a number of resources designed to assist states in the implementation of hospital Presumptive Eligibility (“PE”), as authorized under the Affordable Care Act (“ACA”).  According to CMS, the purpose of PE is to offer a “streamlined, expedited path to [Medicaid] coverage for [eligible] individuals in all states.”

The ACA directs that hospital PE be available in every state.  In the bulletin, CMS informed that beginning in January 2014, all states must “ensure that hospitals that participate in the Medicaid program can begin making PE determinations to provide temporary Medicaid coverage to individuals who qualify including children, pregnant women, parents, individuals formerly in foster care, and if applicable in a state, adults covered under the new low-income adult eligibility group.”

The bulletin included a brief discussion of three important policy considerations as states implement hospital PE: 1) the PE period varies depending on whether the individual submits a full application; 2) a full Medicaid application is not a condition of eligibility for PE; and 3) states may not require verification of information provided as a condition of PE.

Finally, CMS offered a link to access a set of frequently asked questions regarding the hospital PE application process, the eligible populations, the qualified entities that can make hospital PE determinations, qualification standards for participating hospitals, and the federal matching funds available.  The link also provides access to templates for training materials and model agreement forms. In the future, CMS plans to post a model PE application; samples of acceptable PE applications; and a model memorandum of understanding for states to use with participating hospitals in the near future.

Read the full bulletin.

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