Presumptive Eligibility

The Presumptive Eligibility (PE) process allows qualified providers to make PE determinations for certain eligibility groups to receive temporary health coverage under the Indiana Health Coverage Programs (IHCP) until official eligibility is determined.

Special note: For information about the presumptive eligibility process for inmates, see the Presumptive Eligibility for Inmates web page.

Overview - presumptive eligibility process

 

Aid categories
  • Infants
  • Children
  • Pregnant women
  • Adults ages 19-64 without Medicare
  • Parents/caretakers
  • Former foster care children (ages 19-26)
  • Individuals seeking family planning services
Qualified providers*
  • Acute care hospitals
  • Psychiatric hospitals
  • Federally qualified health centers (FQHCs)
  • Rural health clinics (RHCs)
  • Community mental health centers (CMHCs)
  • Local health departments
  • Advanced practice registered nurse practitioners*
  • Family/general practitioners*
  • Certified nurse midwives*
  • General internists*
  • Obstetricians or gynecologists*
  • General pediatricians*
  • Medical clinics*
  • Family planning clinics*
Delivery system Fee-for-service, except PE Adult, which is managed care

*QPs for PE for low-income pregnant women only. Other QPs can make PE determinations for all applicable eligibility groups.

Select the following links for more information: