Summary
Pennsylvania Medical Assistance (Medicaid) has updated hospital presumptive eligibility (PE) determination criteria effective October 1, 2026, to restrict federal Medicaid coverage for certain noncitizen groups. Refugees, asylees, humanitarian parolees, and other lawfully present individuals (except those under 21 or pregnant) are now ineligible for PE determinations. Acute care and psychiatric hospitals must immediately update their PE screening procedures to apply the new citizenship/immigration status criteria.
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What to do
by Sep 30, 2026 · 5 steps
01Hospital billing and eligibility teams must update presumptive eligibility screening workflows to reflect new citizenship/immigration status criteria.
02Update PE determination forms and decision trees in billing systems to classify applicants using the new eligibility table (US Citizen, Lawful Permanent Resident, COFA Migrant, Cuban/Haitian Entrant, Temporary Resident, Refugee/Asylee/Parolee, Refugee Unaccompanied Minor, Other Non-Citizens).
03Train all staff conducting PE determinations on the policy changes, emphasizing that refugees, asylees, and parolees are now ineligible for PE unless applicant is under 21 years old OR pregnant OR indicates Cuban/Haitian Entrant/COFA Migrant status.
04Communicate changes to hospital emergency departments, admitting departments, and financial counselors.
05Review and deny any PE determinations for ineligible noncitizen groups effective October 1, 2026 unless exceptions apply.
If missed: Failure to implement these changes will result in improper coverage determinations, claim denials, and potential compliance violations with federal Medicaid rules.
Original notice
MAB2026093002
pa.gov · Always check the source before changing claims.