Hospital Presumptive Eligibility
Certain hospitals are able to enroll eligible individuals in a limited short-term Medicaid coverage through HPE. This is a temporary coverage program.
Eligibility
This temporary coverage is based on financial and other factors for the following coverage groups:
- An individual aged 19-64 who is not on Medicare and meets income limits
- Note: Individuals with Medicare may still qualify for Medicaid through other options.
- A parent or caretaker relative of a child or children in the home under age 18, or 19 if the child is still in school
- A pregnant person
- A child under age 19
- A former foster care individual under 26 who was in foster care at the time of their 18th birthday
- A person diagnosed with breast or cervical cancer
- A person eligible for limited Medicaid benefit for family planning coverage only
Pregnant individuals can only get HPE coverage one time during their pregnancy. All other individuals can only get HPE coverage one time per year.
Income Limits
Qualifying for HPE depends on household income and family size. For your family size, count the number of people included on your federal taxes. If you don’t file taxes, count how many children and stepchildren under age 19 live in your home.
If you are pregnant, include the number of unborn children in your family size. Household income is based on what the individual reports as monthly income. Monthly income is based on the gross income (before taxes and deductions) of all members included in the family size. Income limits depend on the covered group you qualify for.
HPE Covered Services
Pregnant women
[PDF] English | Spanish
Other individuals
[PDF] English | Spanish
Plan First
[PDF] English | Spanish .
Read a list of HPE Approved Hospitals.