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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 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?

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 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 March 1, 2014.

Family Size:

Maximum Monthly Income:

Maximum Annual Income:

2

$2,793

$33,505

3

$3,513

$42,153

4

$4,234

$50,801

5

$4,955

$59,448

 

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 services.

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 PEPW.