Title: 
Headings:  Presumptive Medicaid Eligibility
Provider
 
Information
 
Release

Presumptive
 
Medicaid
 
Eligibility
 

What
 
is
 
Presumptive
 
Medicaid
 
Eligibility?
 


Content: For
 
pregnant
 
women,
 
the
 
goal
 
is
 
to
 
offer
 
prenatal
 
care
 
as
 
quickly
 
as
 
possible
 
in
 
order
 
to
 
prevent
 
birth
 
defects
 
or
 
complications
 
and
 
assure
 
a
 
healthy
 
baby. Presumptive
 
Medicaid
 
eligibility
 
for
 
children
 
may
 
result
 
from
 
an
 
ER
 
visit
 
or
 
hospital
 
admission
 
or
 
a
 
visit
 
to
 
an
 
outpatient
 
setting
 
in
 
which
 
the
 
child
 
has
 
an
 
immediate
 
need
 
for
 
medical
 
care. In
 
both
 
cases,
 
a
 
regular
 
Medicaid
 
application
 
should
 
be
 
submitted
 
to
 
the
 
applicant’s
 
local
 
County
 
Department
 
of
 
Job
 
and
 
Family
 
Services
 
(CDJFS)
 
at
 
the
 
same
 
time
 
presumptive
 
eligibility
 
is
 
determined. In
 
cases
 
of
 
presumptive
 
eligibility,
 
Medicaid
 
coverage
 
begins
 
on
 
the
 
date
 
that
 
the
 
hospital
 
or
 
clinic
 
(known
 
as
 
a
 
“qualified
 
entity”)
 
has
 
made
 
a
 
determination
 
of
 
presumptive
 
eligibility. If
 
the
 
applicant
 
files
 
a
 
regular
 
Medicaid
 
application
 
with
 
the
 
local
 
CDJFS,
 
the
 
presumptive
 
eligibility
 
period
 
lasts
 
until
 
the
 
application
 
is
 
either
 
approved
 
or
 
denied. If
 
the
 
applicant
 
does
 
not
 
file
 
a
 
regular
 
Medicaid
 
application,
 
the
 
presumptive
 
eligibility
 
period
 
will
 
end
 
on
 
the
 
last
 
day
 
of
 
the
 
month
 
in
 
which
 
his
 
or
 
her
 
60th
 
day
 
of
 
coverage
 
ends. The
 
covered
 
Medicaid
 
benefits
 
are
 
DIFFERENT
 
for
 
pregnant
 
women
 
versus
 
children. Presumptive
 
Medicaid
 
coverage
 
for
 
pregnant
 
women
 
includes
 
ONLY
 
ambulatory
 
prenatal
 
care
 
(including
 
prescriptions); inpatient
 
hospitalization
 
including
 
labor
 
and
 
delivery
 
are
 
specifically
 
excluded
 
from
 
the
 
presumptive
 
Medicaid
 
benefit
 
package
 
for
 
pregnant
 
women. Children
 
with
 
presumptive
 
Medicaid,
 
however,
 
receive
 
full
 
Medicaid
 
coverage,
 
including
 
behavioral
 
health
 
services.