Health and Family Services (HFS) filed the rules necessary to implement Hospital Presumptive Eligibility (HPE) as required by the Affordable Care Act (ACA). HPE provision for Illinois Medicaid will allow qualified hospitals to immediately enroll individuals in Medicaid for a temporary period when the hospital determines they are eligible for the state’s Medicaid program.
Medical costs will be covered by the state for care received by individuals under HPE from the date the hospital determines them to be presumptively eligible until:
- The end of the month following the date of HPE determination
- Or until a review of a full application for medical benefits is completed by the state and the individual is found to be ineligible for Medicaid
All participating providers, not just hospitals, will be reimbursed by the state for the healthcare provided during the individual’s presumptive eligibility period. The proposed rules were published in the Illinois Register on January 23, 2015 and were open for public comment for 45 days beginning that day.