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Presumptive Eligibility

Health care providers and Head Start programs can play a major role in finding and enrolling uninsured children through presumptive eligibility. States can authorize “qualified entities” -- health care providers, community-based organizations, and schools, among others -- to screen for Medicaid and Children's Health Insurance Program (CHIP) eligibility and immediately enroll children who appear to be eligible.

Why Implement Presumptive Eligibility?

Presumptive eligibility allows children to get access to Medicaid or CHIP services without having to wait for their application to be fully processed. Qualified entities can also help families gather the documents needed to complete the full application process, thereby reducing the administrative burden on States to obtain missing information.

States Providing Presumptive Eligibility

The following states have elected to provide presumptive eligibility for children in Medicaid and/or CHIP.

State CHIP Medicaid
California No Yes
Colorado Yes Yes
Connecticut Yes Yes
Illinois Yes Yes
Indiana No Yes
Iowa Yes Yes
Kansas Yes Yes
Massachusetts Yes No
Michigan No Yes
Missouri Yes Yes
Montana Yes Yes
New Hampshire No Yes
New Jersey Yes Yes
New Mexico No Yes
New York Yes Yes
Ohio No Yes
Oregon Yes No
Tennessee No Yes
West Virginia No Yes
Wisconsin No Yes