How Presumptive Eligibility Works

EA TI VE S O LU TI O N S When Congress established the State Children’s Health Insurance Program (SCHIP) in 1997, it also enacted presumptive eligibility, a new state option for expediting children’s enrollment in Medicaid.1 Presumptive eligibility helps states cover children more quickly by allowing them to provide immediate, but temporary, enrollment in Medicaid or SCHIP to children who appear to meet program eligibility standards. During a period of presumptive eligibility, children have access to the full range of Medicaidor SCHIPcovered services (for whichever program they are presumed to be eligible), allowing them to receive needed health care immediately rather than waiting for completion of a full eligibility determination. This approach facilitates access to care for uninsured children and contributes to state efforts to increase participation in Medicaid and SCHIP.