Presumptive Eligibility for Inmates

NOTE: County jails interested in participating in the Presumptive Eligibility (PE) for Inmates process should send an email to IndianaInmateMedicaid@fssa.in.gov.

The PE for Inmates process allows Hospital Presumptive Eligibility (Hospital PE) qualified providers (QPs) to enroll eligible inmates into the Indiana Health Coverage Programs (IHCP) for temporary coverage of authorized inpatient hospitalization services.

PE for Inmates is available to individuals who meet the following requirements. The individual must:

  • Be an inmate from a correctional facility operating under the memorandum of understanding or contract with the Indiana Family and Social Services Administration (FSSA)
  • Not be on house arrest
  • Not be pregnant or admitted for labor and delivery
  • Be admitted for inpatient hospitalization
  • Be under the age of 65
  • Meet all other standard PE requirements

Inmates who go through the PE process must complete an Indiana Application for Health Coverage to retain inpatient benefits. Individuals who complete applications and are found eligible will be covered for 12 months. During that time, if an inmate returns to the hospital for inpatient services, the hospital will continue to see the "600" PE code as the inmate's member identification number. The hospital can continue to submit claims using the 600 member ID. If the inmate does not complete an Indiana Application for Health Coverage, his or her PE for Inmates coverage will end on the last day of the month following the month in which the individual was found presumptively eligible, and application through the PE process will not be available for one year. If the individual remains incarcerated after one year, he or she may reapply for coverage through the PE for Inmates process.

Services rendered to individuals covered under the PE for Inmates process will be reimbursed through the fee-for-service (FFS) delivery system at 130% of the FFS rates. Providers are reminded to always verify individuals' eligibility before rendering services. Eligibility can be verified by using Web interChange or through one of the following Eligibility Verification System (EVS) options:

  • Automated Voice Response System
  • Electronic Data Interchange (EDI) 270/271 - Eligibility Benefit Transaction

More information about PE for Inmates is available through the following links:

Direct additional questions or concerns to IndianaInmateMedicaid@fssa.in.gov.