The Patient Protection and Affordable Care Act authorizes states to implement a presumptive eligibility period for select eligibility groups or populations. This will assist individuals who need health coverage and allow healthcare providers to receive payment for services provided before a full Medicaid determination is completed. Presumptive eligibility is determined based on gross income reported at the time of the application. Presumptive eligibility will be determined for an individual whose application is filed online, by a trained qualified entity.
The eligibility groups or populations for which qualified entities determine eligibility presumptively are:
• Pregnant Women
• Infants and Children under age 19
• Parents and Caretaker Relatives
• Adult Group age 19-64
• Former Foster Care Children
• Certain individuals needing treatment for breast or cervical cancer
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