FAQ: Presumptive Eligibility for Pregnant Women (PEPW)

How can I apply for PEPW?

Find an approved PEPW provider to submit a PEPW application. You can do this by calling 1-800-889-9949. Once you find a PEPW provider, they will ask you some questions and determine if you are eligible the same day you apply.

On the same day you are approved for PEPW, you must pick one of the health plans approved by Indiana Medicaid - Anthem, MDwise, or Managed Health Services (MHS). Health services begin right away with the health plan. The provider who does your PEPW application will provide directions on what you need to do next.

You should then apply for Hoosier Healthwise coverage. Your PEPW coverage is temporary, and you must complete an Indiana Application for Health Coverage in order to keep your coverage. If you do not submit an Indiana Application for Health Coverage, your insurance will end. The cost for delivery of your baby is not covered under the PEPW process.

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;
  • Family Size; and
  • 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 PEPW providers. This will help you to determine where you should go for services.

Covered services

What services will I get with PEPW?

PEPW covers doctor visits, tests, lab work, and other care for your pregnancy. It also covers dental care, prescription drugs, and transportation services to doctor appointments. Your health plan will help you find service providers.

What health care is not covered?

Some services are not covered by PEPW including:

  • Care when you are admitted to the hospital;
  • Labor and delivery; and
  • Services that are not for your pregnancy.

These services are covered by Hoosier Healthwise. It is important to get your Indiana Application for Health Coverage submitted so that you can have all of your health care services covered.

For how long am I covered through PEPW?

As long as you have applied for Medicaid, you will remain covered through PEPW until the state decides if you get full Medicaid or not. You need to apply for full Medicaid by the last day of the month following the month your PEPW coverage was started.

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

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

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

With PEPW coverage, you will not have to pay any portion of the cost of covered prenatal services. PEPW 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 PEPW 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 PEPW, will I have to choose a health plan and a doctor?

Yes. Before leaving the doctor's office, you will need to call 1-800-889-9949 and pick a health plan approved by Indiana Medicaid - Anthem, CareSource, MDwise, or Managed Health Services (MHS). You should also pick a doctor during this call.

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

Please call 1-800-889-9949.