Presumptive Eligibility (PE) is a program providing temporary maternity coverage while a pregnant woman is waiting for her Indiana Medicaid application to process. This program offers essential prenatal services to maintain health in the early stages of pregnancy in order to keep women and their babies healthy. To qualify, you must obviously be pregnant, a resident of Indiana, and not currently receiving Medicaid. Your total household income must not exceed the PE program limit, which is 200% above the current poverty level.
Once you are approved for PE, you should apply for Medicaid coverage, as PE only will provide prenatal benefits. If you are already concerned about the cost of your pregnancy, it will be immeasurably helpful to submit an application for Medicaid, as you can still be accepted with income up to 200% of FPL for pregnancy only coverage. Additionally, your PE will be discontinued if you do not apply for Medicaid by the last day of the second month your PE benefits began. Labor and delivery charges are incredibly high without coverage, and it is pertinent to make sure you have a health plan in place to cover the remainder of your pregnancy.
Based on the number of individuals living in your home, earnings are evaluated accordingly. You and your unborn child are counted as two people, and you may add a spouse, and any other children.
How to Apply for PE
You may apply for Presumptive Eligibility at certain clinics or doctor’s offices throughout the state. In order to qualify, you will be asked to take a pregnancy test on the premises, or provide proof of pregnancy from another physician or health center. If you are pregnant, the doctor will conduct an interview and complete all necessary PE forms on your behalf. If you are found eligible, your benefits will start on that day. You will need to provide the doctor or clinic with your name, address, Social Security Number, your family size, and dollar amount of household income.
Locate a designated clinic or doctor near you by calling Medicaid at 800-889-9949 or use the Provider Search engine – remember to search only providers in your area approved for PE.
PE covers a variety of services specific to prenatal care only. The program does not cover hospital stays, labor and delivery, and other health care unrelated to your pregnancy. This is why women on PE must apply for full Medicaid, in order to receive coverage for all types of medical care on a non-temporary basis. Coverage will last for the length of time it takes for your Medicaid application to be reviewed for approval. Once your eligibility is determined, your coverage will either end or continue on Medicaid. Prenatal services through PE are available for no cost.
- Doctor’s office visits
- Lab work
- Dental care
- Prescription drugs related to your pregnancy
Women found eligible for PE are required to select a doctor and a health plan on the date of their application. The enrollment broker will be called to make your decision, and the facility where you apply will assist you in the process. Your health plan options include Anthem, MDwise, and Managed Health Services (MHS).
Contact Indiana Medicaid
1. Indiana Medicaid. “Presumptive Eligibility”. http://member.indianamedicaid.com/programs–benefits/medicaid-programs/presumptive-eligibility.aspx