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May, 2011

Presumptive Eligibility: Providing Access to Health Care Without Delay and Connecting Children to Coverage

Center for Children and Families
by: Tricia Brooks

As a state policy option designed to expedite immediate access to needed health care services, presumptive eligibility does double duty in effectively connecting uninsured, eligible children and pregnant women to health coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The policy gives states the option to train specific “qualified entities,” such as health care providers, schools, government agencies and community-based organizations, to screen for eligibility and temporarily enroll children and pregnant women in Medicaid or CHIP.1 Individuals determined presumptively eligible can secure covered health care services without delay while they complete the regular application process for ongoing coverage. 

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