Hospital Presumptive Eligibility

Per the Affordable Care Act (ACA), hospitals who meet the requirements of participation will be given the opportunity to become Qualified Hospitals (QH) by completing Hospital Presumptive Eligibility (HPE) Medical Assistance training.

A Qualified Hospital is a hospital that:

• Participates as a Georgia Medical Assistance Provider;
• Notifies DCH of its election to make PE determinations;
• Agrees to make PE determinations consistent with DCH’s policies and procedures;
• Assists individuals in completing and submitting the Single Streamlined Medical Assistance application and understanding any documentation requirements; and
• Has not been disqualified by DCH.

Presumptive eligibility is an expedited process of enrolling eligible Georgia residents into the Medical Assistance program. Eligibility is based on the individual(s) taxable income, tax filer status, household size, citizenship/immigration status and residency.

HPE may be determined for the following groups:

• Parent/Caretaker with child(ren) under age 19
• Child(ren) under age 19
• Former Foster Care
• Pregnant Women
• Women’s Health Medical Assistance

The HPE program is administered by the Department of Community Health (DCH).