Expanding Presumptive Eligibility as a Key Part of Medicaid Reform

Abstract

As the incoming Biden administration prepares its health reform agenda, simplifying access to Medicaid should emerge as a high priority. Medicaid has proven critical during the coronavirus disease 2019 (COVID-19) pandemic, in that enrollment has grown by 5.3 million individuals (to 76.5 million) from February to August 2020 as a result of reduced incomes and job loss. Even with this growth, further enrollment simplification is critical, given Medicaid's role as a pathway for many individuals to affordable COVID-19 testing, treatment, and vaccination.Simplifying enrollment means expanding the use of presumptive eligibility, long a staple of Medicaid policy. Even if near-term legislation expanding presumptive eligibility is not feasible, the Biden administration and states could expand presumptive eligibility as part of a broader effort to test approaches to improving Medicaid performance during public health emergencies.

State-Level Variability in Hospital Presumptive Eligibility Programs

“…Our prior work has shown that HPE is a pathway to obtaining full scope Medicaid, with 70% of HPE enrollees sustaining Medicaid at 6 months and having increased access to posthospitalization health care services. The expansion of HPE to more coverage groups could allow states to expand access to health care …”

“…The expansion of HPE to more coverage groups could allow states to expand access to health care. 5 , 6 …”

“…The expansion of HPE to more coverage groups could allow states to expand access to health care. 5,6 States can also increase transparency of HPE information for hospitals and patients. In 7 states, availability of HPE information was so limited that patients would encounter challenges learning about HPE from official government websites.…”

Presumptive eligibility for pregnancy Medicaid and timely prenatal care access

“…Researchers and advocates have called on presumptive eligibility as a feasible policy lever for improving access to coverage and care for low-income populations; indeed, these policies have recently been expanded upon to improve timely care access through Medicaid during the COVID-19 pandemic. [22][23][24][25][26] Further research should explore the effects of presumptive eligibility for Medicaid on broader populations, as well as the effects of these policies on additional health care and health outcomes.…”

“…In summary, our findings suggest that presumptive eligibility policies for pregnancy Medicaid are associated with small improvements in early prenatal care access among birthing parents with lower education levels. Researchers and advocates have called on presumptive eligibility as a feasible policy lever for improving access to coverage and care for low‐income populations; indeed, these policies have recently been expanded upon to improve timely care access through Medicaid during the COVID‐19 pandemic 22–26 . Further research should explore the effects of presumptive eligibility for Medicaid on broader populations, as well as the effects of these policies on additional health care and health outcomes.…”