Hospital Presumptive Eligibility
CMS has approved Arizona’s Hospital Presumptive Eligibility plan.
Based on provisions in the Affordable Care Act, Arizona has developed a Hospital Presumptive Eligibility (HPE) process that allows qualified hospitals to temporarily enroll persons who meet specific federal criteria for full Medicaid benefits in AHCCCS immediately. Hospitals will use special features in Arizona’s electronic application, Health-e-Arizona Plus (HEAplus), to process HPE applications.
Hospitals that choose to participate in HPE must meet performance standards for continued participation. Details about performance standards are included in the Hospital Presumptive Eligibility Agreement.
HPE provides eligible persons with temporary full Medicaid coverage. Persons who are approved for HPE may receive Medicaid services from any registered AHCCCS provider.
How hospitals become qualified to make HPE determinations
Hospitals that want to participate in HPE must meet ALL of the criteria listed below:
- Complete and sign the Hospital Presumptive Eligibility Agreement with AHCCCS.
- Please complete the form online, and then print it for signature and the signature date.
- Scan the signed agreement and email it to AHCCCS at: HEAAHCCCS@azahcccs.gov
- This agreement will not be final until it is reviewed, approved, and signed by AHCCCS.
- Once AHCCCS reviews and approves the agreement, you will receive a copy of the fully executed agreement.
- Have a fully executed Health-e-Arizona Plus Subscription Agreement in place with AHCCCS.
- If you do not already have a HEAplus Subscription Agreement with AHCCCS, please follow the instructions available at: HEAplus Subscription
- Be licensed as a healthcare institution (hospital) by the Arizona Department of Health Services (ADHS) or be a federally operated hospital, including an Indian Health Services or tribally-operated 638 hospital;
- Be an AHCCCS registered provider. Information about AHCCCS provider registration is available at:
AHCCCS registered provider - Operate within the State of Arizona
- All HEAplus users at the hospital and each clinic location that will be making HPE determinations must complete both:
- HEAplus New User training; and
- HPE training provided by AHCCCS. HPE training will be through e-learning. More information will be provided when this training is available.
