Presumptive Eligibility

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New CMS rules state the Oklahoma Health Care Authority (OHCA) must provide Medicaid during a presumptive eligibility period to individuals who are determined by a qualifying hospital, on the basis of preliminary information, to be presumptively eligible subject to the same requirements as apply to the State options under 435.1102 and 435.1103, but regardless of whether the OHCA provides Medicaid during a presumptive eligibility period under such sections.

OHCA is in the process of planning and implementing the presumptive eligibility (PE) program. Below is a list of resources, draft forms, and other documents related to PE. Please direct questions to the OHCA provider reimbursement mailbox at provreimb@okhca.org.