Coronavirus Escape Plan: Presumptive Eligibility in Medicaid and CHIP

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.

LocationPresumptive Eligibility__Children’s MedicaidPresumptive Eligibility__Children’s CHIP (Total=36)Presumptive Eligibility__Pregnant WomenPresumptive Eligibility__ParentsPresumptive Eligibility__Childless AdultsFootnotes
United States19 Yes10 Yes30 Yes9 Yes8 Yes
AlabamaNoNoNoNoN/A
AlaskaNoN/A (M-CHIP)NoNoNo
ArizonaNoNoNoNoNo
ArkansasNoNoNoNoNo
CaliforniaYesN/A (M-CHIP)YesNoNo
ColoradoYesYesYesNoNo
ConnecticutYesYesYesNoNo
DelawareNoNoNoNoNo
District of ColumbiaNoN/A (M-CHIP)YesNoNo
FloridaNoNoYesNoN/A
GeorgiaNoNoYesNoN/A
HawaiiNoN/A (M-CHIP)NoNoNo
IdahoYesYesYesYesYes1
IllinoisYesYesYesNoNo
IndianaYesNoYesYesYes2
IowaYesYesYesYesYes
KansasYesYesYesNoN/A
KentuckyNoNoYesNoNo
LouisianaNoNoNoNoNo
MaineNoNoYesNoNo
MarylandNoN/A (M-CHIP)NoNoNo3
MassachusettsNoNoNoNoNo
MichiganYesN/A (M-CHIP)YesNoNo
MinnesotaNoN/A (M-CHIP)NoNoNo
MississippiNoNoNoNoN/A
MissouriYesYesYesNoN/A
MontanaYesYesYesYesYes
NebraskaNoN/A (M-CHIP)YesNoN/A
NevadaNoNoNoNoNo
New HampshireYesN/A (M-CHIP)YesYesYes
New JerseyYesYesYesYesYes
New MexicoYesN/A (M-CHIP)YesNoNo4
New YorkYesYesYesNoNo
North CarolinaNoNoYesNoN/A
North DakotaNoN/A (M-CHIP)NoNoNo
OhioYesN/A (M-CHIP)YesYesYes
OklahomaNoN/A (M-CHIP)NoNoN/A
OregonNoNoNoNoNo
PennsylvaniaNoNoYesNoNo
Rhode IslandNoN/A (M-CHIP)NoNoNo
South CarolinaNot ReportedNot ReportedNot ReportedNot ReportedNot Reported
South DakotaNoNoNoNoN/A
TennesseeNoNoYesNoN/A5
TexasNoNoYesNoN/A
UtahNoNoYesNoNo
VermontNoN/A (M-CHIP)NoNoNo
VirginiaNoNoNoNoNo
WashingtonNoNoNoNoNo
West VirginiaYesNoYesYesYes
WisconsinYesNoYesNoNo
WyomingYesNoYesYesN/A
Footnotes
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.
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