Presumptive eligibility is a state policy option that gives states the flexibility to train health care providers, schools and other community-based organizations and programs to screen eligibility and temporarily enroll eligible persons in Medicaid and CHIP. Currently 31 states use presumptive eligibility for pregnant women and 16 states enroll children presumptively. The following issue brief examines how the Affordable Care Act (ACA) envisions a broader role for presumptive and highlights the ways in which states have implemented the policy for pregnant women and children.