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Presumptive Eligibility

Presumptive Eligibility for Pregnant Women

Presumptive Eligibility for Pregnant Women (PEPW) offers temporary coverage of prenatal care services to pregnant women while their Medicaid applications are pending. The goal of the PEPW process is to offer health care to women early in their pregnancies, so they stay healthy and have healthy babies. Presumptive Eligibility means that we presume you are eligible for the Hoosier Healthwise program based on some preliminary information that you provide.

PEPW is for pregnant women who are not currently receiving Medicaid. In addition, your family income must be below a certain amount. PEPW is not for women who already have Medicaid or who do not live in Indiana.

If you are pregnant and think you need help from Medicaid, contact your doctor or clinic and ask for help applying for Presumptive Eligibility for Pregnant Women and Medicaid. If you do not have a doctor, use the provider search tool to find a doctor in your area.

You can learn more about PEPW under Programs and Benefits by clicking here.  If you have further questions, please call us at 1-800-889-9949.

Hospital-Based Presumptive Eligibility

Some hospitals participate in Hospital-Based Presumptive Eligibility.  They are able to make temporary Medicaid eligibility determinations for very low income children, families, pregnant women, and former foster care children.  They may also determine temporary eligibility for individuals seeking family planning services.