Establishing Performance Standards for Hospital-Based Presumptive Eligibility: Considerations for State Medicaid Agencies

Prepared for the Robert Wood Johnson Foundation's State Health Reform Assistance Network

Manatt authored an issue brief for the State Health Reform Assistance Network, a program of the Robert Wood Johnson Foundation, that examines the "presumptive eligibility" (PE) option for hospitals, allowing them to use preliminary information to enroll people temporarily in Medicaid and facilitate their enrollment into ongoing coverage.

Though presumptive eligibility is not a new concept in Medicaid, the Affordable Care Act (ACA) for the first time gives hospitals-rather than states-the authority to decide whether to participate in PE. While states are obligated to allow hospitals that participate in Medicaid to conduct PE determinations, they have the authority to oversee quality, including requiring training and setting performance standards. Titled "Establishing Performance Standards for Hospital-Based Presumptive Eligibility: Considerations for State Medicaid Agencies," the brief describes the flexibility available to states in establishing performance standards and discusses the approaches they may want to consider.

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