Qualified Hospital (QH) Presumptive Eligibility

Florida Medicaid enrolled hospital providers may elect to make presumptive eligibility determinations in accordance with federal law and state policy.

Qualified hospitals (QH) may make presumptive eligibility determinations for:

• Pregnant women
• Infants and children under age 19
• Parents and other caretaker relatives
• Former foster care children

Provider Qualifications

Hospitals must meet the following qualifications in order to become qualified to determine presumptive eligibility:

• Be enrolled in the Florida Medicaid program as a hospital provider (provider type 01)
• Complete a Florida Medicaid Hospital Provider Enrollment Application
• Ensure all employees who are authorized to make presumptive eligibility determinations complete the training certification requirements and maintain documentation of these certifications in a central location
• Make determinations consistent with state eligibility policy
• Assist individuals with submitting full Medicaid eligibility applications and supporting documentation within certain timeframes
• Continually meet the following performance standards: 
  • 95% of individuals determined to be presumptively eligible will submit a regular application before the end of the presumptive eligibility period.
  • 90% of the individuals who submit an application before the end of the presumptive eligibility period will be determined eligible for regular Medicaid.

Updates

Helpful Links

• Department of Children and Families (DCF)
• State Plan Amendment [1.5MB PDF]
• Sign up for Florida Medicaid Health Care Alerts (Provider Alerts)