HPE Eligibility & Compliance

HPE determinations in real time. Every time.

Fast-track Hospital Presumptive Eligibility with CoverMe's automated HPE program — completed Medicaid applications delivered to your desktop within seconds, with state compliance guaranteed.

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The ACA Channel Most Providers Underuse

Temporary Medicaid, the day care is delivered.

Under the Affordable Care Act, Hospital Presumptive Eligibility lets qualified hospitals enroll eligible individuals in temporary Medicaid immediately — and get reimbursed just as if the patient were enrolled in standard Medicaid at the time of treatment.

CoverMe identifies patients who will qualify in near real-time, with all the necessary data compiled and scored for accurate PE determinations. Eligible groups include children under 19, former foster care children, pregnant women, parents, and caretakers.

Compliance

Meet state policies and program compliance requirements without fail — timeliness and accuracy assured.

Automation

Replaces the manual processes of onsite Medicaid vendors — saving providers time and money.

Immediate Coverage

Presumptively eligible patients are enrolled in temporary Medicaid on the spot — coverage that starts when care starts.

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HPE is your strongest hedge against the 2027 Medicaid changes.

With 6-month redeterminations and work-requirement churn pushing eligible patients out of coverage, presumptive eligibility puts temporary Medicaid in place the day care is delivered — before the paperwork gap becomes your write-off. Why act now →

Benefits

The fastest, most reliable path to Medicaid determination.

Replaces traditional Medicaid eligibility vendors and speeds up your process Provides another channel to apply for coverage — improving Medicaid access Ensures appropriate reimbursement for services delivered Supports informed enrollment recommendations during screening

FAQ

Frequently Asked Questions

How does CoverMe assist providers in completing HPE determinations?

CoverMe offers real-time identification of patients who will be eligible for Medicaid enrollment, and supports providers in making informed enrollment recommendations during the screening process.

How long does eligibility verification take?

It's effectively instant — CoverMe's real-time verification lets providers identify Medicaid-eligible patients almost immediately.

How does CoverMe help meet HPE compliance requirements?

CoverMe assesses eligibility and auto-fills applications, replacing manual processes and ensuring data accuracy — enabling providers to meet state standards and HPE program performance metrics.

Are state-specific HPE requirements built into the system?

Yes. CoverMe is customizable, so state-specific eligibility rules and conditions are configured into the system for your state.

Patients get covered. Providers get paid.

See an HPE determination completed in real time — on your state's rules.

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