Coronavirus Escape Plan: Presumptive Eligibility in Medicaid and CHIP

Why Implement Presumptive Eligibility?

States Providing Presumptive Eligibility

The Henry J. Kaiser Family Foundation

Health care providers and Head Start programs can play a major role in finding and enrolling uninsured children through presumptive eligibility. States can authorize “qualified entities” — health care providers, community-based organizations, and schools, among others — to screen for Medicaid and Children’s Health Insurance Program (CHIP) eligibility and immediately enroll children who appear to be eligible.

Presumptive eligibility allows children to get access to Medicaid or CHIP services without having to wait for their application to be fully processed. Qualified entities can also help families gather the documents needed to complete the full application process, thereby reducing the administrative burden on States to obtain missing information.

What does Medicaid and CHIPS Cover

1. Idaho implemented the Affordable Care Act Medicaid expansion for adults effective January 2020. Presumptive eligibility is applied to expansion adults.

2. Indiana does not use CHIP funds or income limits for the child population.

3. Maryland utilizes presumptive eligibility for individuals leaving correctional facilities if an application cannot be submitted prior to release.

4. New Mexico has presumptive eligibility for parents and other adults in Medicaid, but it is limited to those in correctional facilities (state prisons/county jails) and health facilities operated by the Indian Health Service, a Tribe or Tribal organization, or an Urban Indian Organization.

5. In 2019, Tennessee eliminated presumptive eligibility in Medicaid.

The following states have elected to provide presumptive eligibility for children in Medicaid and/or CHIP.

Location	Presumptive Eligibility__Children’s Medicaid	Presumptive Eligibility__Children’s CHIP (Total=36)	Presumptive Eligibility__Pregnant Women	Presumptive Eligibility__Parents	Presumptive Eligibility__Childless Adults	Footnotes
United States	19 Yes	10 Yes	30 Yes	9 Yes	8 Yes
Alabama	No	No	No	No	N/A
Alaska	No	N/A (M-CHIP)	No	No	No
Arizona	No	No	No	No	No
Arkansas	No	No	No	No	No
California	Yes	N/A (M-CHIP)	Yes	No	No
Colorado	Yes	Yes	Yes	No	No
Connecticut	Yes	Yes	Yes	No	No
Delaware	No	No	No	No	No
District of Columbia	No	N/A (M-CHIP)	Yes	No	No
Florida	No	No	Yes	No	N/A
Georgia	No	No	Yes	No	N/A
Hawaii	No	N/A (M-CHIP)	No	No	No
Idaho	Yes	Yes	Yes	Yes	Yes	1
Illinois	Yes	Yes	Yes	No	No
Indiana	Yes	No	Yes	Yes	Yes	2
Iowa	Yes	Yes	Yes	Yes	Yes
Kansas	Yes	Yes	Yes	No	N/A
Kentucky	No	No	Yes	No	No
Louisiana	No	No	No	No	No
Maine	No	No	Yes	No	No
Maryland	No	N/A (M-CHIP)	No	No	No	3
Massachusetts	No	No	No	No	No
Michigan	Yes	N/A (M-CHIP)	Yes	No	No
Minnesota	No	N/A (M-CHIP)	No	No	No
Mississippi	No	No	No	No	N/A
Missouri	Yes	Yes	Yes	No	N/A
Montana	Yes	Yes	Yes	Yes	Yes
Nebraska	No	N/A (M-CHIP)	Yes	No	N/A
Nevada	No	No	No	No	No
New Hampshire	Yes	N/A (M-CHIP)	Yes	Yes	Yes
New Jersey	Yes	Yes	Yes	Yes	Yes
New Mexico	Yes	N/A (M-CHIP)	Yes	No	No	4
New York	Yes	Yes	Yes	No	No
North Carolina	No	No	Yes	No	N/A
North Dakota	No	N/A (M-CHIP)	No	No	No
Ohio	Yes	N/A (M-CHIP)	Yes	Yes	Yes
Oklahoma	No	N/A (M-CHIP)	No	No	N/A
Oregon	No	No	No	No	No
Pennsylvania	No	No	Yes	No	No
Rhode Island	No	N/A (M-CHIP)	No	No	No
South Carolina	Not Reported	Not Reported	Not Reported	Not Reported	Not Reported
South Dakota	No	No	No	No	N/A
Tennessee	No	No	Yes	No	N/A	5
Texas	No	No	Yes	No	N/A
Utah	No	No	Yes	No	No
Vermont	No	N/A (M-CHIP)	No	No	No
Virginia	No	No	No	No	No
Washington	No	No	No	No	No
West Virginia	Yes	No	Yes	Yes	Yes
Wisconsin	Yes	No	Yes	No	No
Wyoming	Yes	No	Yes	Yes	N/A