Expedited Medicaid Application Processing

Yes, it may be possible in some states to have one’s Medicaid application expedited, or in other words, have one’s Medicaid determination rushed, or “fast-tracked”. While federal law gives Medicaid agencies 45 days (90 days for applications based on disability) to review and approve or deny one’s Medicaid application, there are some circumstances in which the eligibility determination may be expedited. For instance, when one has a medical emergency or an immediate need for assistance.

Pennsylvania will expedite one’s Medical Assistance (PA Medicaid) application if there is a medical emergency, such as an immediate need for a procedure or surgery. In fact, one’s eligibility will be determined within five business days of one’s request for an expedited application. To make this request, one should write on their paper application, or if applying online, in the notes section, “Medicaid Emergency – Please Expedite”. Persons can also make this request by calling their County Assistance Office after their application is submitted. Additionally, the emergency should be verified by the medical provider, either in writing or by phone.

In New York, if there is an Immediate Need for home care, specifically for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS), which provides assistance with daily living activities, one’s application can be fast-tracked. “Immediate Need” requires that one does not (or will not) have an informal (unpaid) caregiver to provide them with care, does not receive assistance via a home care services agency, does not have specialized / adaptive equipment or supplies to assist one in meeting their needs, and does not have Medicare or a third party insurance that can pay for their care. Once all of the required documentation is submitted, a Medicaid determination will be made no later than 7 days, and a determination for PCS or CDPAS (if eligible for Medicaid) will be made no later than 12 days.

There is also presumptive eligibility, which allows persons to access Medicaid temporarily while their application is pending. Presumptive eligibility is based on information provided by the individual. Essentially, if it is thought that one is Medicaid-eligible, they will receive Medicaid benefits while the formal Medicaid determination is being made. While not all states offer presumptive eligibility, most commonly it is extended to children and pregnant women. California, however, offers Hospital Presumptive Eligibility (HPE) for state residents, including seniors not on Medicare.

Via HPE, one can immediately receive Medi-Cal (CA Medicaid) benefits for 60 days while going through the application process (if specific criteria is met). To apply for HPE, one must visit an approved PHE provider (hospital) and they will submit an online application on behalf of the individual. Presumptive eligibility is determined immediately.

If, and how, states expedite Medicaid determination or offer presumptive eligibility is state-specific. Therefore, it is best to contact one’s state Medicaid agency and inquire as to if “expediated processing” is permitted, and if so, how to request it.