Presumptive Eligibility (PE)
Presumptive Eligibility (PE) is a process that offers short-term
coverage of services. The program is available to children,
parents/caretakers, and other adults. The goal of the program
is to make sure you have immediate access to health care.
Your short-term coverage will end if you do not
complete a Medicaid application.
Below are many answers to popular questions:
Who can get PE coverage?
You can get PE coverage if you are not currently receiving
Indiana Medicaid coverage. The following groups of
individuals may qualify for PE:
- Pregnant Women
- Former Foster Children
You must live in Indiana, and your family income must be below a
certain amount. In order to continue your coverage, you
will need to complete a full application as soon as
Why should I submit a Medicaid application?
Approval for PE is NOT the same as being approved for
Medicaid. Your PE coverage is only temporary while you submit
a Medicaid application and your Medicaid application is
pending. Your PE will end if you do not apply for Medicaid by
end of the next month.
It is very important that you respond promptly to all requests
from us regarding your Medicaid application . If you do not
respond to our questions, you will not be eligible for Medicaid
coverage, and you will be responsible for paying all of your health
How does the PE process work?
You will be asked a few questions at the hospital or
clinic. You should be prepared to provide the following
- Home address;
- Phone number;
- Date of birth;
- Social Security Number;
- Family size; and
- Amount of monthly/annual income.
You will also be asked a few additional questions to make sure
you qualify for the correct coverage.
What is covered?
Your temporary coverage will depend upon your aid category:
- If you qualify as a Parent/Caretaker, Infant, Child, or Former
Foster Child, you will be eligible for all services covered under
Hoosier Healthwise Package A. If you would like more
information about the services covered, you should refer to What Is
Covered By Hoosier Healthwise.
- If you qualify as a Pregnant Woman, you will be eligible for
doctor visits, tests, lab work, and other care for your
pregnancy. You will also have coverage for dental care,
prescription drugs, and transportation services to doctor
appointments. This will not cover labor and delivery costs, you
must apply for Medicaid.
- If you qualify for Family Planning coverage, you will only be
eligible for services covered by the Family Planning Eligibility
Program. These services include family planning visits,
laboratory tests, pap smears, condoms, and birth control. If
you would like more information about the services covered, you
should refer to the Family Planning
- If you qualify as an Adult, you will be eligible for services
covered under the HIP Basic Plan. You will be required
to pay copays for all services. If you'd like to learn
more about the services covered under HIP Basic, you should refer
to the Healthy Indiana Plan website.
What is "fast track"?
If you qualify under the Adult category, the hospital or clinic
will ask you to select a health plan. You will be
presumptively eligible for the Healthy Indiana Plan (HIP).
Your health plan will send you a letter in the mail requesting a
$10 "fast track" payment to get your full coverage effective
faster. If you pay this $10 and complete your Medicaid
application, your full coverage with HIP will begin sooner without
a gap in coverage. While this payment is optional, you
are encouraged to pay it so that you can begin receiving your full
benefits sooner. If you would like more information
about HIP, you should refer to the Healthy Indiana Plan website.
How can I complete the full application?
The PE application is NOT a full Medicaid
application; it provides only temporary coverage. You
should complete a full application as soon as possible to make sure
you do not lose any benefits. You can submit a full
application in a number of ways:
- At the provider where you were found presumptively
- Over the phone at 1-800-403-0864; or
- At a Division of Family Resources (DFR) local office.
You can find answers to even more questions under the Frequently
Asked Questions page.