As of January 1, 2014, the Affordable Care Act (ACA) gives qualified hospitals the opportunity to take advantage of hospital presumptive eligibility (HPE) to enroll individuals likely to be eligible for Medicaid immediately into the program. Choosing to become an HPE site is a hospital decision; states cannot require or preclude hospital participation. States do, however, have an important role to play in designing program components, educating participating hospitals about their responsibilities, and overseeing hospital performance.
This fact sheet details state and hospital roles and responsibilities in implementing HPE programs. It outlines components necessary for HPE programs as well as requirements for state plan amendment submission. It also includes a hypothetical example to illustrate how the HPE determination process can help an uninsured individual during a hospital visit.