Presumptive Medicaid now set to expire in January

The Commonwealth Healthcare Corp. has officially confirmed that the “Presumptive Eligibility for Medicaid” has been extended another quarter, or three months.

CHCC CEO Esther Muña said that Presumptive Eligibility for Medicaid, or PE, which was supposed to expire in October, has been extended another three months and is now set to conclude in January 2023.

Muña explained that the presumptive Medicaid program was established pursuant to the National Public Health Emergency put in place due to COVID-19. Because of this, a two-months’ notice should be given before the public health emergency is lifted, ending the program.

However, in a previous interview with Muna, she said the two months’ notice should have been given last Aug. 14, as a result, because ample time was not given, the program has been extended.

“The expiration was supposed to be October but we were supposed to be given two months’ notice of when it expires. The two months’ notice should’ve been on or before Aug. 14. Because they did not give that notice, that means the Public Health Emergency will most likely be extended another quarter. We’re looking at the public health emergency ending in January 2023,” she said.

“We’re supposed to be given ample time to notify the community that the Public Health Emergency is ending. Once the Public Health Emergency Ends, then Medicaid presumptive eligibility ends,” Muña earlier said.

Presumptive eligibility, or PE, is an expedited process of enrolling eligible residents in the CNMI Medicaid program. It allows patients to have their care covered while waiting for their application to be fully processed.

It offers immediate access to health care while applying for regular Medicaid or other health coverage. You can start using PE for Medicaid coverage right away for Medicaid covered services, such as doctor visits, hospital care, and some prescription drugs.

Starting the day you are approved for PE, you are able to go to any health care provider that accepts Medicaid.

Individuals and families are eligible for Medicaid if their attested gross income does not exceed 180% of the Supplemental Security Income federal benefit, which is about $28,800 annually for a family of four.

Medicaid, under the Centers for Medicare & Medicaid Services, has already started the “unwinding down” process which essentially means vetting all the applications for those who were presumed eligible for Medicaid and determining whether they really are eligible for regular Medicaid or not.

“All I do know is that the Medicaid agencies and the states are being advised to start what they call ‘unwinding down’ to come up with a plan on how to address eligibility. So I know that they’ve been advised on how to do it and so they’re working on it and it does require that they actually review the applications,” Muna said.