Last October Gov. McCrory caused a stir, and raised some eyebrows, when he said that the state may be forced to expand Medicaid due to a “new” regulation.
The policy to which he was referring is called presumptive eligibility. Presumptive eligibility allows states to give permission to hospitals and other providers to temporarily enroll certain people in Medicaid. North Carolina, for example, allows presumptive eligibility for pregnant women. That means if a hospital does an initial check and it looks like a pregnant woman is likely to qualify for Medicaid then the hospital can temporarily enroll her and get paid for the services it provides. Meanwhile, an application for full Medicaid can be processed without a disruption in care.
This policy is critical for ensuring that patients get care and providers get paid.
In states with efficient systems that can process Medicaid eligibility in real time, this temporary measure is not as important. In states where parents are having to ration medicine for their children due to a backlog in processing Medicaid applications, presumptive eligibility is a critical tool.
Health reform gave hospitals more latitude to presumptively enroll patients, even if the state has not granted the hospital permission to participate in the program. Other providers, notably Community Health Centers, however, are still not able to use presumptive eligibility to enroll children in Medicaid. The Community Health Centers are still limited to enrolling pregnant women.
Ultimately, the state needs to fix its computer system. In the meantime, we need to get care to children. We could start by granting Community Health Centers, and possibly other providers, the ability to temporarily enroll likely eligible kids in Medicaid while DHHS clears its application bottle neck.
And until the state expands Medicaid to all low-income people we will need every splint and bandage we can find to patch our broken system.