Under the Affordable Care Act (ACA) and regulations revised by the Cabinet for Health and Family Services (CHFS) in January, hospitals can grant presumptive Medicaid eligibility to individuals who qualify under the new Medicaid income eligibility criteria or to pregnant women. In February, the Cabinet’s contractor, HP, conducted webinar training programs for hospital staff. Since that time, KHA has worked with the Department for Medicaid Services (DMS) to obtain answers to additional questions involving presumptive eligibility. The questions and answers are provided below. Please distribute this information to your staff.

Question: If a hospital grants presumptive eligibility (PE) to an individual, is the individual limited to receiving hospital services only from the hospital which granted the PE or may they receive covered services at any hospital? (KHA was advised this was stated in the HP training program.)

DMS Answer: (Lee Guice, DMS) PE coverage is not limited to the hospital which assisted the PE member.

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According to an AHA "Newsflash," on January 24, the Centers for Medicare and Medicaid Services (CMS) clarified that hospitals can continue to use service vendors to assist them in making Medicaid presumptive eligibility determinations under the Patient Protection and Affordable Care Act.

Many hospitals use outside vendors to help with eligibility assessments and enrollment. CMS's announcement, which was welcomed by AHA, would still hold hospitals accountable for accurate presumptive eligibility determinations.

CMS issued the clarification in a series of FAQs on hospital presumptive eligibility. The FAQ on this issue can be found on page six.

The Kentucky Department for Medicaid Services (DMS) has announced expanded services that are covered under Presumptive Eligibility (PE) as part of the Affordable Care Act (ACA). Qualified hospitals will be allowed to determine eligibility for temporary coverage for those who do not have insurance coverage.

HP Enterprises will conduct webinars, in conjunction with DMS, for hospitals to become qualified in determining temporary eligibility under the PE program. The webinar is designed to offer instruction and assistance to providers in determining who is eligible for temporary coverage and how to submit a PE request. Your registration and completion of this training constitutes your election to make PE determinations.

Hospital chief executive officers are encouraged to forward this information to the appropriate staff members in their facility who will be screening for Medicaid eligibility. Please read the final regulation for additional details on PE.

Choose one of the three sessions below...