FAQ: Presumptive Eligibility

How can I apply for PE?

You can apply for PE at certain clinics or doctors' offices.  While there, you will be asked to take a pregnancy test or show proof of pregnancy from another doctor or clinic.

If you are pregnant, the doctor or clinic will ask you some questions and will fill out all the PE forms for you.  If you qualify for PE, your coverage will begin that day.

What should I bring with me to the designated clinic or doctor's office?

You will need the following information on your first visit:

  • Name
  • Address
  • Phone Number
  • Social Security Number
  • Number of People in Your Family
  • Dollar Amount of Monthly Family Income

How can I find a designated clinic or doctor in my area?

Please call us at 1-800-889-9949.  You may also visit our 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 PE providers. This will help you to determine where you should go for services.

Covered services

Can I visit the clinic or doctor even if I'm not certain that I'm pregnant?

Yes.  Any woman who thinks she is pregnant and whose income allows her to participate should visit a designated clinic or doctor to find out if she is pregnant and to apply for PE.  However, if you are not pregnant, you will not be eligible for PE, and you will have to pay for the cost of the pregnancy test.

What services will I get with PE?

PE care includes doctor visits, tests, lab work, and other care for your pregnancy.  It also includes dental care and prescription drugs.

What health care is not covered?

PE will not pay for hospital stays, labor and delivery, and services unrelated to your pregnancy. If you become eligible for Medicaid then these services will be included. Because of this, it is very important to complete your Medicaid eligibility application.

How long will PE coverage last?

You will qualify for PE until your Medicaid eligibility is determined. However, if you do not complete your Medicaid application and interview, your PE could end very quickly. It is very important that you respond to all requests regarding your coverage. If you do not respond, you will not be enrolled in Medicaid, which means you will have to pay for all prenatal and labor and delivery costs.

Will my first visit to the designated provider be paid for?

If you qualify for PE, all medical services received on that day from the designated clinic or provider will be paid by PE. If you do not qualify for PE, you will have to pay for the services.

Will I have to pay for some of the services in PE?

With PE coverage, you will not have to pay any portion of the cost of covered prenatal services. PE will not pay for hospital stays, labor and delivery, and services unrelated to your pregnancy. If you become eligible for Medicaid, then these services will be included. Because of this, it is very important to complete the follow-up interview for your Medicaid eligibility application.

Will my baby have health care coverage if I am covered by Medicaid for the baby's delivery?

If you have Medicaid coverage, your baby will also be covered from the day of birth.

If you do not have Medicaid coverage for labor and delivery, including those who had PE but did not qualify for Medicaid coverage, you will have to apply for Medicaid coverage for your newborn baby. The Medicaid application process can take some time. It is best to make sure that you respond to all requests for information and begin Medicaid coverage before the baby is born.

Health plans

If I qualify for PE, will I have to choose a health plan and a doctor?

Yes. You must choose your health plan and your doctor while you are at the designated clinic or doctor's office applying for PE. You will make your choice by calling the enrollment broker. The clinic or doctor's office will help you with this process while you are in their office.

Whom should I contact if I have more questions about PE?

Please call us at 1-800-889-9949.