Presumptive Eligibility Medicaid

Presumptive Eligibility (PE) is an expedited process of enrolling eligible applicants in the Medicaid program. PE allows certain providers, designated as Qualified Providers (QP)/ Qualified Hospitals (QH), to make a preliminary Medicaid eligibility determination for an applicant.

This temporary coverage is available prior to a formal determination of eligibility by the local Right from the Start Medical Assistance (RSM) Group or the Division of Family and Children Services (DFCS).

Each PE Medicaid program has specific policy regulations and procedures.  These policies and procedures are outlined in each of the PE Provider Manuals located at under the provider tab.

QPs/QHs can find additional PE resources below:

PE Hospitals

PE Pregnant Women

PE Women’s Health Medicaid -- Updated 08/21/14