An Enroll America Toolkit to help maximize the number of Americans who enroll in health coverage

What is Presumptive Eligibility?

With presumptive eligibility (PE), an individual can be temporarily enrolled in Medicaid immediately if it appears they are eligible. When an individual provides a hospital with a few basic pieces of information (about their income and household size), a PE determination can be made.

Last Updated: 3/10/2014

The Affordable Care Act brings many opportunities for hospitals to become even more active in enrolling people in the coverage they need. One of these new opportunities allows hospitals to enroll patients and their families who are likely to be eligible in Medicaid for a temporary "presumptive eligibility" period using a vastly simplified application.

As part of our ongoing commitment to provide enrollment stakeholders like hospitals the tools they need to maximize the number of Americans who enroll in health coverage, Enroll America has put together this toolkit, which is designed to help hospital administrators understand and make the most of this unique opportunity.

We hope that this toolkit provides hospital administrators with information and guidance on implementing the new presumptive eligibility option. Hospitals have always played—and will continue to play—an important role in connecting patients to health care and health coverage. Hospitals are invaluable partners in the effort to maximize the number of people who enroll in reliable, comprehensive health coverage.

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