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Facilitating Enrollment: Presumptive Eligibility for Children

Presumptive eligibility, which establishes short-term temporary eligibility based on declaration of family income, may be highlighted as a particularly effective method of facilitating enrollment into SCHIP because it:

• Allows immediate coverage of all covered services and guarantees payment to providers who render these services.

• Brings enrollment process into community-based settings. Broad range of sites are permitted to make presumptive determinations (including doctors’ offices, clinics, local health departments (LHDs), Community Health Centers (CHCs), school-based health centers, hospitals, as well as Supplemental Women, Infants and Children's Program (WIC) clinics, Head Start programs, and groups that determine eligibility for subsidized child care).

One caution issued with the use of presumptive eligibility is that programs must establish systems for ensuring that families do submit a formal application at a future point in time.

Related Questions

Give me an example

• Examples of Effective State Medicaid Outreach Strategies
  • Massachusetts' MassHealth Program
  • Arkansas' ARKids First Program

Give me an overall context

• What Are Some Effective Strategies to Raise the Public’s Awareness of the Availability, to Simplify Eligibility, and to Maximize Enrollment?

Show me other SCHIP Workshop presenter-suggested strategies

• SCHIP Guidance - Strategies Suggested by Presenters

Show me some lessons learned

• Overview of the Various Approaches Available for Facilitating Enrollment in SCHIP

Tell me some known or potential problems

• Historical Barriers to Health Program Enrollment

Who presented this material?

• Ian Hill