Presumptive Eligibility

Certain medical facilities including the Department of Public Health (DPH) are approved by the Department of Community Health (DCH) and provide an on-site Presumptive Eligibility (PE) Medicaid certification to pregnant women who apply for and are presumed eligible for Pregnant Women Medicaid.

A Presumptive Eligibility Medicaid application is completed by certified Qualified Providers (QP’s) at these facilities. The purpose of the PE is to provide Medicaid coverage for pregnant women to receive immediate prenatal care. After certification, the PE packet is forwarded to the local DFCS or RSM Outreach Project worker for a full Medicaid determination, as the PE decision is temporary and only covers services performed on an outpatient basis.

Qualified Providers do not verify citizenship and identity for PE applications. This must be done by the DFCS or RSM Project worker when completing the regular Medicaid determination.

Refer to 2067 Presumptive Eligibility Medical Assistance .