HPE is available in most states, and participation is optional. However, the benefits of HPE enable hospitals to deliver a Continuum of Coverage envisioned by the law, thereby benefiting the hospitals and patients. In order to participate in this beneficial program, hospitals must submit the appropriate paperwork to their state Medicaid office. They are also required to meet a series of qualifications, standards, and training to enroll and stay in compliance with the program. Find out what the eligibility rules and standards are for your state.
Hospital Presumptive Eligibility (HPE) is a healthcare policy under the Affordable Care Act (ACA) that lets hospitals provide temporary Medicaid coverage to uninsured individuals who may likely be eligible for Medicaid under specific categories. The temporary eligibility ensures that qualified individuals get improved access to Medicaid and other critical services. Further, it encourages and assists the individual in submitting a full Medicaid application.
HPE allows qualified hospitals to get reimbursed for the care they provide for eligible individuals as if they enrolled in Medicaid.
A hospital is qualified to make PE determinations if
Once qualified to make PE determinations, the hospital must ensure that:
HPE determinations are based on 3 core eligibility criterias that are based on whether or not the individual:
When an individual visits a healthcare facility, the PE worker in the facility will take the following steps: