The Affordable Care Act (ACA) gives qualified hospitals the opportunity to determine Presumptive Eligibility (PE) for certain Medicaid-eligible populations. Presumptive Eligibility is a Medicaid Program that facilitates immediate access to healthcare for uninsured Kentuckians who do not already have other coverage.

Determinations are made on limited information provided by an individual about their income, household size, citizenship, and residency status.

The temporary enrollment provides individuals immediate access to medical care and a pathway to longer-term Medicaid coverage. This enrollment ensures provider compensation for all covered services, including hospital-based services, while a final eligibility determination is made.

Types of PE Programs in Kentucky

Hospital PE

• This type of PE is provided by Qualified Hospitals and covers most services provided by hospitals and primary care providers.
  

Pregnancy PE

• Pregnancy PE coverage is more limited than the coverage provided by Hospital PE. Coverage is limited to ambulatory prenatal care services delivered in an outpatient setting.