Basic Considerations
PE Medical Assistance provides outpatient prenatal care to pregnant women during the period that a formal Medical Assistance application pends with DFCS. All Medical Assistance services given by any participating Medical Assistance provider are covered during the presumptive period with exceptions of inpatient hospital and delivery services.
Hospital Presumptive Eligibility (HPE) covers all Medical Assistance related services that are covered by the specific COA requested.
Emergency Medical Assistance (EMA) cannot be completed in the Presumptive Eligibility process.
Hospital Presumptive Eligibility may be determined for the following groups:
Pregnant Women
Parent/Caretaker with Child(ren) under age 19
Child(ren) under 19
Former Foster Care Children
Women in treatment for Breast or Cervical Cancer (WHM)
The PE Medical Assistance eligibility period begins on the date the PE application is approved and ends when DFCS determines eligibility or ineligibility, but no later than at the end of the month following the month of the PE approval. (Ex. PE application approved 4/5/24 which begins coverage 4/5/24 through 5/31/24.)
The QP or QH issues temporary Medical Assistance certificates and Notice of Action (Approval/Denial) to applicants. If the applicant is approved for PE Medical Assistance, a plastic card is sent. The applicant should receive this within 7 to 10 business days. If the plastic card is not received, lost or stolen, the member must contact the Member Contact Center at 1-866-211-0950.
DFCS cannot process applications for PE or issue eligibility forms for PE.
Potential Qualified Providers include the Department of Public Health, federally funded health centers, primary care centers receiving migrant funding and/or homeless funding, hospital outpatient clinics and hospital-based special prenatal clinics.
As of July 1, 2011, Public Health became the Department of Public Health and is now a Qualified Provider.