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
You will need the following information on your first visit:
- 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
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
Can I visit the clinic or doctor even if I'm not certain that
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
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
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
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
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
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
If I qualify for PE, will I have to choose a health plan and a
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.