Hospital Presumptive Eligibility
Hospital Presumptive Eligibility (HPE) is designed to provide a pathway to longer-term Medicaid coverage by allowing participants to have timely access to health care services through an on-site, temporary eligibility determination.
Section 2202 of the Patient Protection and Affordable Care act (PPACA) allows hospitals that are participating Medicaid providers to determine eligibility for Medical Assistance. Hospitals are encouraged to participate in HPE, but are not required to participate.
HPE allows hospitals to be reimbursed for services covered under the Maryland Medicaid Fee-for-Service (FFS) program during a temporary coverage period--roughly 60 days maximum--even if the individual is ultimately determined to be ineligible for Medicaid or CHIP.
HPE coverage begins on the day the eligibility determination is made. Only one period of HPE coverage is allowed in any twelve-month period. HPE applicants do not have to receive services at the hospital at the time of an HPE coverage determination.
Only hospital employees may conduct HPE determinations; HPE functions may not be subcontracted to other entities. Hospitals participating in HPE are required to provide applicants with the full Maryland MA application and assist in its completion.
Hospital employees must attend required trainings and pass an HPE knowledge test prior to making HPE determinations. The Department will update a training schedule for upcoming training dates.
For general questions about HPE, please view HPE Frequently Asked Questions.
Hospital Presumptive Eligibility (HPE) is a very short-term Medical Assistance (MA) coverage program. You may apply for HPE at any participating hospital.
You must provide true and accurate information about your income and family circumstances on your HPE application. If you are approved, you will receive a notice of approval from the hospital that day. The notice will serve as proof of coverage. Your coverage will terminate if you do not enroll in full MA coverage within 60 days.
You must submit a complete MA application as soon as possible to continue to receive MA. The hospital where you apply for HPE can assist you in completing the full MA application. If an application is not received, your coverage will close and you will no longer receive MA benefits.
If you are denied for HPE coverage, you will receive a notice of denial from the hospital. You may not appeal the denial decision. You may, however, complete a full MA application if you wish to proceed with a full MA eligibility determination.
Training for HPE Hospital Workers
The Maryland Department of Health now offers quarterly trainings for hospital workers to become HPE workers. Mark your calendars for the next training and deadline to register.
February 2021, deadline to register is Jan 31, 2021
May 2021, deadline to register is April 26, 2021
August 2021, deadline to register is July 26, 2021
December 2021, deadline to register is November 22, 2021
To register for the HPE Training, eligible hospitals' HPE Primary Contact must email firstname.lastname@example.org a list of attendees by the designated training deadline. Only names submitted by the hospital's HPE Primary Contact will be considered registered. The Department will use that list of names as verification when assessing HPE Knowledge Test results.
The Department will send the HPE Training link to the eligible hospitals' HPE Primary Contact. The training webinar will be accessible Monday-Thursday of the first week of the training month. Hospital workers may attend the HPE Training at a time that is convenient.
Following the close of the webinar, the Department will send the HPE Knowledge Test to eligible hospitals' HPE Primary Contacts. Regardless of when hospital workers participate in HPE training, the Department will not release the HPE Knowledge Test until the training has closed. Each participating hospital's HPE Primary Contact is responsible for sharing the HPE Knowledge Test, distributed by Google Forms, to those who attend the HPE Training.
Additional trainings may be made available if there is enough interest for a specific month. Please email email@example.com
MDH HPE Agreement (for hospitals)
HPE Frequently Asked Questions (August 2017)
HPE Brief: August 2017
COMAR 10.09.91 Hospital Presumptive Eligibility
Income Guidelines (January 2021)