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.
Why Implement Presumptive Eligibility?
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
States Providing Presumptive Eligibility
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|
|District of Columbia||No||N/A (M-CHIP)||Yes||No||No|
|New Hampshire||Yes||N/A (M-CHIP)||Yes||Yes||Yes|
|New Mexico||Yes||N/A (M-CHIP)||Yes||No||No||4|
|North Dakota||No||N/A (M-CHIP)||No||No||No|
|Rhode Island||No||N/A (M-CHIP)||No||No||No|
|South Carolina||Not Reported||Not Reported||Not Reported||Not Reported||Not Reported|
|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.|