Presumptive Eligibility

Presumptive Eligibility (PE) is a program that offers temporary coverage of prenatal care services to pregnant women while their Medicaid applications are pending. The goal of the PE program is to offer health care to women early in their pregnancies, so they stay healthy and have healthy babies.

Below are many answers to popular questions; however, if you have further questions, please call us at 1-800-889-9949.

Who can participate?

PE is for pregnant women who are not currently receiving Medicaid. In addition, your family income must be below a certain amount. If you are pregnant and think you will need help from Medicaid, you should contact your doctor or clinic and ask for help applying for PE and Medicaid.

PE is not for women who already have Medicaid or who do not live in Indiana.

Why should I submit a Medicaid Application?

Approval for Presumptive Eligibility (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 be discontinued if you do not apply for Medicaid by the last day of the month following the month your PE was established.

It is very important that you respond promptly to all requests from the State regarding your Medicaid application process following your submission of a Medicaid application. If you do not apply and respond, you will not be eligible for Medicaid coverage, and you will be responsible for paying all of your labor and delivery costs.

Many health care services are not covered under PE. If you do not begin the Medicaid application process, you will lose your PE and be responsible for the cost of the care when you are admitted to the hospital, including labor and delivery, and any services that are not for your pregnancy or for the health of your baby. The costs of your continuing prenatal care, as well as labor and delivery, will only be covered if your Medicaid application is submitted and approved.

For your health and the health of your baby, take the next step and complete the Medicaid application process right away. The same doctor's office or clinic that helped you with your PE determination can help in filling out and submitting your Medicaid application.

How much income can I have and still qualify?

This depends on how many people are in your family. Count yourself, your unborn baby, your spouse, and the children who live with you. If you are under 19, count yourself, your unborn baby, your parents, and siblings if they live with you. These income guidelines are effective from March 1, 2013 to February 28, 2014.

Family Size:	Maximum Monthly Income:	Maximum Annual Income:
2	$2,585	$31,020
3	$3,255	$39,060
4	$3,925	$47,100
5	$4,595	$55,140
6	$5,265	$63,180
7	$5,935	$71,220
8	$6,605	$79,260
For each additional person, add	$670	$8,040