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Presumptive Eligibility

People eligible for Medicaid can enroll on the spot at any hospital, even in the emergency department, so it can cover the cost of their care immediately. This process is referred to as “presumptive eligibility.” A patient who meets basic eligibility standards can fill out a short application that immediately and temporarily provides coverage for the care the patient receives. Patients then have a month to fill out the formal Medicaid application. If the formal Medicaid application does not confirm a person’s eligibility, Medicaid will still pay for the care already provided.

With input from hospital groups including Colorado Hospital Association and the American Hospital Association, Enroll America developed a presumptive eligibility toolkit to help hospital staff learn how the process works.

It is important to note that presumptive eligibility works for hospitals in every state — not only those that opted for the Medicaid expansion. SCL Health advocates for a healthcare system that serves everyone. Presumptive eligibility is an important aspect that ensures more people have access to high-quality, affordable care.