Medicaid HCBS Presumptive Eligibility
States were given credit for having a presumptive eligibility policy or process for one or more Medicaid HCBS programs either on a permanent or a temporary basis in response to the COVID-19 public health emergency. Federal regulations require that Medicaid LTSS applications be processed by state offices within 45 days. For people who need LTSS right away, this is often too long to wait for services to begin. Nursing homes are usually willing to begin services while someone’s application for Medicaid is still pending but HCBS providers typically cannot afford to do this. Presumptive eligibility allows for HCBS services to start and for providers to be paid while the individual’s full application is still being processed. Then Medicaid will cover those costs back to the date of the application. In states with HCBS presumptive eligibility, applicants assessed and presumptively found to be eligible are rarely determined to be ineligible once their full applications are processed. These policies can help people access HCBS almost as quickly as they can access nursing home services, thus helping people to avoid short-term nursing home stays that can turn into much more expensive long-term stays.
Compare State Data
This indicator credits all states indicating having a presumptive eligibility pathway for their HCBS program(s).
AARP Public Policy Institute fielded a survey to state agencies in collaboration with The Lewin Group and US Administration for Community Living that included questions related to HCBS presumptive eligibility. States for which state agency respondents indicated the presence of an HCBS presumptive eligibility pathway.
In addition, states identified as having a presumptive eligibility pathway for HCBS in a 2021 AARP Public Policy Institute on the topic received credit.
AARP PPI, ADRC/No Wrong Door state survey conducted in collaboration with The Lewin Group and US Administration for Community Living” (unpublished, Washington, DC: AARP Public Policy Institute, 2022).
AARP PPI “Presumptive Eligibility for Medicaid Home and Community-Based Services Can Expand Consumer Options” (April 2021, https://www.aarp.org/pri/topics/health/coverage-access/ltss-choices-presumptive-eligibility-medicaid-home-community-based-services/ /node/196)