85. Question: Can a State do presumptive eligibility (PE) under its State Title XXI program?

Answer: Yes, although there is no express provision for PE under Title XXI, a State may craft an equivalent procedure in a non-Medicaid CHIP program as a health initiative. As such, expenditures provided during the PE period are subject to the 10 percent limit for administration, outreach, health services initiatives and other child health assistance and are initially counted against the State’s Title XXI allotment as described in question.

A State, however, has the following options for claiming such expenditures:

a. Identify and Claim PE on Ongoing Basis -No Adjustments. The State can identify and claim FFP for all PE expenditures on an ongoing basis (as such expenditures are incurred and claimed to the State) with no subsequent adjustments after the actual eligibility determination. In this case, the amount of the PE expenditures would be applied against the allotment, would be claimed at the enhanced FMAP, and would be applied against the State’s 10 percent limit. This approach may be the easiest for States to administer and may be best for those States with sufficient room under their 10 percent cap.

b. Report After Actual Eligibility Determination. The State can wait and report potential PE expenditures after the actual determination of eligibility; in that case expenditures would be classified in accordance with the actual eligibility determination:

c. Identify and Claim PE on Ongoing Basis -Adjust After Actual Eligibility Determination. The State can identify and claim FFP for all PE expenditures on an ongoing basis, as such expenditures are paid by the State (as would be done in a. above). However, after the actual determination of eligibility is made, adjustments would be made to reflect the actual eligibility category determination. In this case, the amounts of the PE expenditures would be reported on an ongoing basis, applied against the allotment, would be claimed at the enhanced FMAP, and applied against the 10 percent limit. As actual eligibility determinations are made, the State would make adjustments to the previously reported expenditures as in b. above.