Presumptive Eligibility

The Indiana Health Coverage Programs (IHCP) includes two authorized processes - Presumptive Eligibility for Pregnant Women (PEPW) and Presumptive Eligibility (PE) - by which individuals can be determined presumptively eligible and receive temporary health coverage until the Family and Social Services Administration (FSSA) determines official eligibility. The following table describes the most significant differences between the two processes.

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

Overview - presumptive eligibility process

PEPW Process

PE Process

Aid categories Pregnant women only
  • 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*
  • Advanced practice nurse practitioners
  • Family/general practitioners
  • Certified nurse midwives
  • General internists
  • Obstetricians or gynecologists
  • General pediatricians
  • Federally qualified health centers (FQHCs)
  • Rural health clinics (RHCs)
  • Medical clinics
  • Family planning clinics
  • Local health departments
  • Hospitals*
  • Acute care hospitals
  • Psychiatric hospitals
  • FQHCs
  • RHCs
  • Community mental health centers (CMHCs)
  • Local health departments
Enrollment broker Pregnant women found presumptively eligible must contact the enrollment broker, MAXIMUS, to select a managed care entity (MCE) on the same day that the woman is found presumptively eligible. No requirement
Delivery system Managed care Fee-for-service, except PE Adult, which is managed care

*Acute care hospitals enrolled as PEPW qualified providers (QPs) retain their ability to determine presumptive eligibility for pregnant women under the PEPW process; however, acute care hospitals are no longer being enrolled as PEPW QPs. Acute care hospitals are enrolled as qualified providers under the general PE process.

Select the following links for more information: