Medicaid & CHIP State Health Official Letter Regarding Eligibility Review Pilots For Hospital Presumptive Eligibility Determinations

August 15, 2013
As of January 1, 2014, hospitals participating in Medicaid will be permitted to make presumptive eligibility determinations for uninsured individuals seeking care who appear to qualify for their state’s existing Medicaid program. Hospitals will have this option whether or not the state has elected presumptive eligibility as a state plan option. To monitor eligibility determination error rates, the federal Centers of Medicare & Medicaid Services directed states to implement Medicaid and CHIP Eligibility Review Pilots in place of the previous Payment Error Rate Measurement system.
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