Presumptive Eligibility for pregnant women
Presumptive Eligibility for Pregnant Women (PEPW) is a process
that offers temporary coverage of prenatal care services to
pregnant women while their Medicaid applications are pending.
The goal of the PEPW program is to offer health care to women
early in their pregnancies, so they stay healthy and have healthy
Below are many answers to popular questions; however, if you
have further questions, please call us at 1-800-889-9949.
Who can participate?
PEPW 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 PEPW and Medicaid.
PEPW 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 for Pregnant Women (PEPW)
is NOT the same as being approved for
Medicaid. Your PEPW coverage is only temporary while you
submit a Medicaid application and your Medicaid application is
pending. Your PEPW will be discontinued if you do not apply
for Medicaid by the last day of the month following the month your
PEPW 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 PEPW. If
you do not begin the Medicaid application process, you will lose
your PEPW 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 PEPW
determination can help in filling out and submitting your Medicaid
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 March 1, 2014.
How can I find a designated clinic or doctor in my area?
Please call us at 1-800-889-9949. You may also visit use
the Provider Search for a
list of locations near you.
Note: When searching for a provider, you have the option
to search only the providers in your area who are approved PEPW
providers. This will help you to determine where you should go for
Presumptive Eligibility for Pregnant Women Brochure
Take this information with you! You can print out the
attached PEPW brochure and have all of the
critical PEPW process information to take with you.
Many of your Presumptive Eligibility questions can be answered
in our FAQs section dedicated to