Hospital Presumptive Eligibility

What is Hospital Presumptive Eligibility (HPE)?

Certain hospitals are able to enroll eligible individuals in a limited short-term Medicaid coverage through HPE. This is a temporary coverage program.

Who qualifies for HPE?

This temporary coverage is based on financial and other factors for the following coverage groups:

  • An individual aged 19-64 who is not on Medicare and meets income limits
    • Note: Individuals with Medicare may still qualify for Medicaid through other options.
  • A parent or caretaker relative of a child or children in the home under age 18, or 19 if the child is still in school
  • A pregnant person
  • A child under age 19
  • A former foster care individual under 26 who was in foster care at the time of their 18th birthday
  • A person diagnosed with breast or cervical cancer
  • A person eligible for limited Medicaid benefit for family planning coverage only

Pregnant individuals can only get HPE coverage one time during their pregnancy. All other individuals can only get HPE coverage one time per year.

What are the income limits?

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 are pregnant, include the number of unborn children in your family size. Household income is based on what the individual reports as monthly income. Monthly income is based on the gross income (before taxes and deductions) of all members included in the family size. Income limits depend on the covered group you qualify for.

Where to learn more

To learn more about HPE:

[PDF] Pregnant women (English) 
[PDF] Pregnant women (Spanish) 
[PDF] Other individuals (English) 
[PDF] Other individuals (Spanish) 
[PDF] Plan First (English) 
[PDF] Plan First (Spanish) .

Read a list of HPE Approved Hospitals.