Presumptive Eligibility

Presumptive Eligibility (PE) allows individuals to receive temporary medical assistance while their eligibility is being determined for ongoing medical coverage. Presumptive Eligibility is divided into two categories: Baby Your Baby (BYB) and Hospital Presumptive Eligibility (HPE).

Eligibility for PE is based on your household size (including your unborn baby), U.S. citizenship or lawful permanent residency status, Utah residency and monthly gross income. Income limits are updated every year. Ask your BYB or HPE representative for more information. You will not qualify for PE if you are currently covered on a different Medicaid program or have received a recent denial and your circumstances have not changed.

PE coverage begins the day your application is approved. Your PE coverage will continue until your ongoing Medicaid application is approved or denied.

You will still want to apply for regular Medicaid if you do not qualify for PE since the application is only a brief look to see if you are eligible for temporary coverage.

Applying for ongoing medical benefits is not a requirement for PE. If you choose not to apply for ongoing medical benefits, you can mark the “opt-out” question on the application.