Presumptive eligibility allows qualified entities — health care providers, community-based organizations, hospitals and schools — to screen for Medicaid eligibility and immediately enroll eligible individuals for services without having to wait the full application processing time.
What is Hospital Presumptive Eligibility (HPE)?
Hospitals can immediately determine Medicaid eligibility for certain individuals who are likely to be eligible. Eligibility under HPE is temporary but allows immediate access to coverage. HPE ensures the hospital will be reimbursed for services provided during this temporary coverage period--60 days maximum--even if Medicaid later finds the individual ineligible. HPE provides individuals with an opportunity to connect to longer-term coverage options.
Apply to Become a Qualified HPE Entity
To become a qualified entity, the hospital must be a participating Maryland Medicaid provider in good standing with the Maryland Department of Health.
Download and complete the application.
Required HPE Staff Training and Certification
Only approved HPE entities are eligible for HPE Training.
Hospital employees must attend the required training and pass an HPE certification test prior to making HPE determinations.
Request Training
A hospital’s HPE primary contact must email mdh.HPE@maryland.gov to request training. The email must include a list of attendees. The Maryland Department of Health will only register those on the list.
Resources
Contact
For more information or questions, see contact by topic hospital presumptive eligibility.
