Fill and Sign the Presumptive Eligibility for Pregnant Women Faq Form

Presumptive Eligibility for Pregnant Women Frequently Asked Questions 1. What is Presumptive Eligibility for Pregnant Women (PE for Pregnant Women)? The PE for Pregnant Women program allows Qualified Providers (QPs) to grant immediate, temporary Medicaid coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy to low-income, pregnant patients, pending their formal Medicaid application. 2. What is a Qualified Provider (QP)? A QP is a Medicaid provider who participates as a PE for Pregnant Women provider under Title 42 United States Code , Section 1396r-1 (Section 1920 of Title XIX of the Social Security Act ). 3. When was the PE for Pregnant Women program originated? The program originated in November 1993. 4. What is changing in the PE for Pregnant Women program? Currently, QPs enroll individuals in the program using a manual paper application process. During the first quarter of 2017, the recipient enrollment process will be automated. Providers who meet the eligibility requirements as governed by the PE for Pregnant Women program can enroll individuals through an electronic process. 5. Who is potentially eligible for PE for Pregnant Women? To qualify applicants must:  Have income below the monthly limit for household size.  Be a resident of the United States.  Not be currently receiving coverage through a state Medicaid program.  If pregnant, not have had a PE enrollment period during the current pregnancy 6. What is the basis for a PE for Pregnant Women determination? The PE determination is based on the applicant's self-attestation of income, household size and state residency provided on the Presumptive Eligibility for Pregnant Women Program Application form. 7. When does the PE for Pregnant Women enrollment period begin and end? The enrollment period begins on the day in which the individual is determined eligible for the PE for Pregnant Women program. The enrollment period ends either: If an individual does not submit an insurance affordability application prior to the PE end date, PE ends on the last day of the following month in which the individual was determined eligible for PE. For example , if an individual is determined eligible on March 3, 2017, PE coverage ends on April 30, 2017. If an individual submits an insurance affordability application prior to the PE end date, PE coverage ends on the day in which the eligibility determination is made based on the insurance affordability application (approved or denied). For example , if an individual was determined eligible on July 3, 2017, and submitted an insurance affordability application prior to the PE end date of August 31, 2017, and a determination was made on August 25, 2017, PE coverage ends on August 25, 2017. 8. Is a Social Security Number needed to apply for the PE for Pregnant Women program? It is highly recommended that a Social Security number is provided. The SSN is optional on the Presumptive Eligibility for Pregnant Women Program Application .