Presumptive Eligibility
for Pregnant Women

Presumptive Eligibility (PE) for Pregnant Women started July 1, 2009. PE allows pregnant women to receive earlier coverage of prenatal care while their HHW applications are in process. Women found to be presumptively eligible will have coverage for ambulatory prenatal services. The PE eligibility period begins on the date a Qualified Provider completes the PE application process. PE does not cover hospice, long-term care, inpatient care, labor and delivery services, abortion services, postpartum services, sterilization, and services unrelated to the pregnancy or birth outcome.

To be eligible for PE, a pregnant woman must meet the following qualifications:

• Have a gross family income at or below 200% of the federal poverty level,
• Be an Indiana resident,
• Be a U.S. citizen or qualified non-citizen,
• Cannot be a current Medicaid member, and
• Cannot be currently incarcerated.

How the application process works:

A Qualified Provider completes an application for PE through Web Interchange. Upon completing the application, the pregnant women will review, complete and sign the pre-populated application for Hoosier Healthwise and the QP will fax it to the DFR. The applicant must call the enrollment broker in order to select a PMP and an MCO to activate the PE eligibility. Once PE eligibility is activated, providers may begin to bill for services. Women are eligible for PE only one time per pregnancy. PE coverage will extend until a woman's HHW eligibility is determined. PE eligibility will terminate the day after a HHW determination is made, if the woman fails to cooperate with DFR requests or on the last day of the month that follows the PE determination if the woman does not submit a HHW application. For more information visit www.indianamedicaid.com under the Managed Care section.

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