Hospital Presumptive Eligibility

Hospital presumptive eligibility. A May MassHealth provider bulletin describes coverage under a new process called hospital-determined presumptive eligibility.

Participating hospitals can make a preliminary decision that someone is likely to be eligible for MassHealth Standard, or CarePlus & start coverage right away. The hospital-determined coverage begins on the day of determination by the hospital. If someone files a full application by the end of the following month, coverage continues until MassHealth makes a determination. If someone does not file an application on time, hospital determined coverage ends at the end of the following month.

People with hospital determined coverage will get a letter from the hospital & from MassHealth but will not get a MassHealth card, and will have fee for service (not managed care) coverage.

Only participating hospitals can make determinations. As of May 30, 14 hospitals had signed contracts to participate including Boston Medical Center, Cambridge Health Alliance, Baystate and U Mass Memorial. However, more hospitals are signing up to participate every week.