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Presumptive Eligibility for Medicaid and CHIP Coverage

Published by Centers for Medicare & Medicaid Services | U.S. Department of Health & Human Services | Catalog Last Checked: May 26, 2026 at 03:43 PM | Dataset Last Updated: January 24, 2019
Health care providers and Head Start programs can play a major role in finding and enrolling uninsured children through presumptive eligibility. States can authorize “qualified entities” -- health care providers, community-based organizations, and schools, among others -- to screen for Medicaid and CHIP eligibility and immediately enroll children who appear to be eligible. Presumptive eligibility allows children to get access to Medicaid or CHIP services without having to wait for their application to be fully processed. Qualified entities can also help families gather the documents needed to complete the full application process, thereby reducing the administrative burden on States to obtain missing information.

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