Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment

July 15, 2013
Starting January 1, 2014, hospitals will be permitted to presume that some uninsured patients are eligible for Medicaid and bill the state for their care. These uninsured patients include children, pregnant women, parents and caretaker relatives, former foster children, women with breast or cervical cancer, and individuals seeking coverage for family planning services. States cannot hold hospitals liable for the costs of care for patients incorrectly assumed to be eligible for Medicaid. However, states can disqualify a hospital with inaccurate presumptive eligibility rates.
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