Section 1920, 1920A and 1920B of the Social Security Act permits states to authorize "qualified entities" to determine presumptive eligibility for certain Medicaid coverage groups and to immediately enroll select groups who appear to be eligible. Starting In July 2015, the Bureau for Medical Services will allow Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Free Clinics and Community Behavioral Health Centers to enroll as qualified presumptive eligibility providers.
The Affordable Care Act gave hospitals the option as of January 2014 to determine presumptive eligibility (PE) for certain Medicaid coverage groups. A qualified hospital may elect to make PE determinations for populations whose eligibility is determined using the Modified Adjusted Gross Income (MAGI) methodology. Determinations are made based on preliminary information, and according to policies and procedures established by the Bureau for Medical Services.
Individuals identified as a PE Authorized Worker must take the training course available at www.onlinelearning.wv.gov/student
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