Presumptive Eligibility

The Presumptive Eligibility (PE) Determination process is available to hospitals and their affiliated facilities that participate with Medicaid in Montana. Personnel from these facilities must be trained and certified to make Presumptive Eligibility determinations for short-term, temporary coverage for the following coverage groups:

  • Healthy Montana Kids;
  • Healthy Montana Kids Plus
  • Parent/Caretaker Relative Medicaid;
  • Pregnant women (ambulatory prenatal care);
  • Adults between the ages of 19 and 64;
  • Adults between the ages of 18 and 26 who were in Foster Care and receiving Medicaid at age 18; and
  • Individuals between the ages of 19 and 64 who have been screened and diagnosed with Breast or Cervical Cancer.

Note: Employees of county health departments or similar facilities may make Presumptive Eligibility determinations for Pregnant Woman coverage but may not make determinations for other coverage groups. 

Personnel who make PE determinations must recertify annually.

Please contact us at HHSPresumptive@mt.gov if you have questions, need training or supplies, or need to verify information about PE.

To take the Presumptive Medicaid training and become certified:

  1. Access Montana DPHHS eLearn.
  2. Login into the site
  3. Click the Employee Development option.
  4. Click Human & Community Services and scroll down.
  5. Click on Presumptive Medicaid tab.
  6. Follow the instructions as given.

Presumptive Eligibility Guide