Simulation of Medicaid and SCHIP Eligibility: Implications of Findings From 10 States. Final Report.. 1. Presumptive Eligibility


Presumptive eligibility rules in the Medicaid program allow certain, qualified health care providers to grant pregnant women immediate, typically 60 days, of Medicaid coverage at the provider site. Formal eligibility would be made during the presumptive period. SCHIP programs have the option of providing presumptive eligibility. In most states, the only programs using presumptive eligibility rules are the Medicaid poverty expansion programs. Examples are California, Colorado, Connecticut, Florida, and New Jersey. In California, the TANF program also offers presumptive eligibility for families in emergency situations, and in Massachusetts, all but the TANF program offer presumptive eligibility to all applicants. Few S-SCHIP programs have taken up this option, but the program in New York offers one 60-day period of presumptive eligibility for each child.