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Hospital Presumptive Eligibility (HPE) is a streamlined process that qualified hospitals can use to immediately enroll patients who are likely eligible under Arizona’s Medicaid eligibility guidelines for a temporary period of time.
The conditions of eligibility for the HPE program are based on the categories listed below; a customer must fall into one of these categories and meet all of the requirements within that category:
· Adult (MA401)
· BCCTP (MA404)
· Caretaker Relative (MA405)
· Child (MA406)
· Pregnant Woman (MA410)
· Young Adult Transitional Insurance (MA416)
Term |
Definition |
Hospital Presumptive Eligibility (HPE) |
Temporary coverage for people who are likely to qualify for AHCCCS Medical Assistance. NOTE Eligibility for HPE is determined by qualified hospitals
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Customers who meet all of the requirements for the HPE program receive full AHCCCS Medical Assistance services package. See MA302 for details about the service packages.
HPE services are paid for by AHCCCS on a fee-for-service basis.
Customers do not pay a premium for coverage under the HPE program. Customers in the HPE program do not have co-payments.
This requirement applies to the following program:
Program |
Legal Authorities |
Hospital Presumptive Eligibility (HPE) |
42 USC 1396r-1 42 USC 1396r-1a 42 USC 1396r-1b 42 CFR 435.1102 42 CFR 435.1103 AAC R9-22-1601 |