There’s also another temporary coverage program. Certain hospitals may be able to enroll eligible individuals in short-term Medicaid coverage through Hospital Presumptive Eligibility (HPE). This temporary coverage is based on both financial and non-financial eligibility for the following coverage groups:
- An individual aged 19-64, not on Medicare with income at or below 138% of poverty
- A parent or caretaker relative of a child or children in the home under age 18 or 19 if the child remains in school
- A pregnant woman
- A child under age 19
- An individual under 26 who was a former foster care child
- A person who has been diagnosed with breast or cervical cancer
- A person eligible for limited Medicaid benefit for family planning coverage only
For more information about Presumptive Eligibility, please refer to covered services for [PDF] pregnant women (English) - [PDF] pregnant women (Spanish) and for [PDF] other individuals (English) - [PDF] other individuals (Spanish) or for [PDF] Plan First (English) - [PDF] Plan First (Spanish). You may also view a list of HPE Approved Hospitals.
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’re a pregnant woman, include the number of unborn in your family size.
Household income is based on what the individual reports as monthly income. Monthly income is based on the
gross income of all members included in the family size. Income limits depend on the covered group for
which you are eligible.
For more information, review the income limits chart for the various groups.
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