Presumptive eligibility for Medicaid enrollment varies across country

Presumptive eligibility--a facet of the Medicaid program that allows specific entities to temporarily enroll some patients for coverage-- is being used unevenly throughout the United States, according to a study in Health Affairs.

Thirty-three states are currently using presumptive eligibility guidelines to enroll children, pregnant women or both, the study reports. Under the program, federally-qualified health centers, hospitals and even schools may enroll individuals based on their income.

Citing data from other studies, Health Affairs concluded that presumptive eligibility programs can boost overall enrollment in the Medicaid program by about 6.4 percent, as well as encourage those enrolled temporarily to seek permanent eligibility by filling out a full application.

Among the states that do not use presumptive eligibility are Louisiana, Mississippi, Alabama, Oregon, Washington, Hawaii and Alaska.

Medicaid eligibility and enrollment has become a point of contention as the Affordable Care Act has rolled out--it is considered a vital financial boost for hospitals, which prefer to have the relatively low payments from the Medicaid program than no payments at all from the uninsured. Altogether, about half of the states have declined to expand Medicaid eligibility under the ACA, citing the financial strain on their budgets. Nevertheless, some of the states say that their Medicaid programs will have to expand anyway.

Under the ACA, hospitals that participate in Medicaid may presumptively enroll any person who meets the income threshold. However, they may not enroll under the expanded income eligibility guidelines if the state is not participating in the Medicaid expansion.

Health Affairs noted though that several states have adopted safeguards against Medicaid fraud. New Mexico, for example, may disqualify a provider from presumptive eligibility if less than 90 percent of those enrolled in this manner fail to submit a full Medicaid application, or if more than 10 percent of applications submitted contain errors.

To learn more:
- read the Health Affairs article

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