§1396r–1b Presumptive Eligibility for Certain Breast or Cervical Cancer Patients

Summary

States may let people who look like they qualify for Medicaid because of breast or cervical cancer get short-term, temporary Medicaid while their full application is decided. That temporary coverage begins when an approved organization, called a "qualified entity," decides from basic information that the person meets the cancer-related criteria. It ends when the state makes a final eligibility decision or, if the person does not file a full application, on the last day of the month after the month the quick decision was made. A qualified entity is a group that can receive Medicaid payments and that the state agency says can make these quick decisions. The federal government can limit which groups qualify, and states can set further limits too. The state must give qualified entities the application forms and information to help people fill them out. When a qualified entity finds someone presumptively eligible, it must notify the state agency within 5 working days and tell the person they must file a full Medicaid application by the last day of the month after the month the quick decision was made. The person must meet that deadline. Care given during this temporary period by providers who can be paid under the state plan and that is covered by the plan will count as Medicaid for federal payment purposes.