Presumptive Eligibility

New CMS rules state the Oklahoma Health Care Authority (OHCA) must provide Medicaid during a presumptive eligibility period to individuals who are determined by a qualifying hospital, on the basis of preliminary information, to be presumptively eligible subject to the same requirements as apply to the State options under 435.1102 and 435.1103, but regardless of whether the OHCA provides Medicaid during a presumptive eligibility period under such sections.

OHCA is in the process of planning and implementing the presumptive eligibility (PE) program. Below is a list of resources, draft forms, and other documents related to PE. Please direct questions to the OHCA provider reimbursement mailbox at provreimb@okhca.org.

Last Modified on May 30, 2023

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.