Presumptive Eligibility Home

Presumptive Eligibility for Pregnant Women is a process to provide coverage to women while the Hoosier Healthwise Application is under review by the Division of Family Resources (DFR). This program began on July 1, 2009.

Women found to be Presumptively Eligible (PE) will have coverage for ambulatory prenatal services while the application and determination process for Hoosier Healthwise/Medicaid is completed. Providers will be reimbursed for covered services provided during the PE period, beginning on the date that a Qualified Provider (QP) determines the woman to be presumptively eligible. The woman's Hoosier Healthwise/Medicaid eligibility determination will subsequently be completed by the DFR.

Enrollment centers that are not qualified providers for the Presumptive Eligibility (PE) program can assist pregnant women by helping them complete and submit Hoosier Healthwise (HHW) Applications and providing a referral to a qualified provider. However, it is critical that only ONE HHW Application be submitted for a member. For more information, see BR200949, dated November 17, 2009.

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