Presumptive Eligibility for Pregnant Women (PE-PW) is a Medicaid health care program that allows pregnant women who are likely to be eligible for regular Medicaid health care to receive prenatal care for a limited time without having to go through the full application process before seeking care.
In other words, pregnant mothers are presumed to be eligible before their Medicaid application has been processed, providing immediate access to much needed prenatal health care.
PE-PW covers physician visits for prenatal care (for example, regular check-ups to monitor the health of both you and your baby) and provides necessary medical care in a regular doctor’s office setting. PE-PW also covers emergency room prenatal visits, prescription drugs related to pregnancy, and prenatal laboratory tests.
PE-PW does not cover services if you are admitted to a hospital. This means labor and delivery services, or services not related to prenatal care, will not be covered.
Frequently Asked Questions
Who qualifies for PE-PW?
Beneficiaries can qualify for PE-PW if they meet all these rules:
- They are residents of Arkansas
- They are pregnant
- They do not already have Medicaid
- They have not had PE-PW during this pregnancy
- They meet income eligibility requirements
How do beneficiaries apply for PE-PW?
To apply for PE-PW, beneficiaries can fill out a Health Care application at any DHS office, online at Access.Arkansas.gov, or by phone.
They will need to provide some basic information when they first apply:
- Full Name
- Address
- Phone Number
- Family/Household Size
- Gross Monthly Income
What services are covered by PE-PW?
Services covered by PE-PW are:
- Physician visits for prenatal care—for example, regular check-ups, monitoring the health of both mother and baby, and providing necessary medical care in a regular doctor’s office setting (but not as a patient admitted into a hospital)
- Emergency Room (ER) prenatal visits
- Prescription drugs related to pregnancy
- Prenatal laboratory tests
What services are NOT covered by PE-PW?
If beneficiaries are admitted into a hospital, services are not covered by PE-PW. This means that labor and delivery services are not covered by PE-PW (but they are covered by regular Medicaid). Also, PE-PW does not cover any services not related to prenatal care.
How long are beneficiaries covered by PE-PW?
Beneficiaries are covered from the day they are found to be eligible for PE-PW services until the end of the month after full determination of their ongoing Health Care eligibility has been made.
For example, if beneficiariesare determined to be eligible for PE-PW services any time in the month of October, then they are covered under PE-PW until the last day of November.
What happens if a client is NOT approved for PE-PW?
There are two different situations to cover here.
- If beneficiariesare found to not be eligible for PE-PW when they first apply, DHS will still review their eligibility for regular Medicaid or other health coverage.
- If beneficiaries are initially approved for PE-PW, but after their full application is reviewed, they are found to not be eligible for Medicaid, they don’t have to worry. They will not be responsible for paying for any visits that they had between the initial approval and the date their presumptive coverage ended. Arkansas Medicaid will pay for those visits for them.
Do beneficiaries need to apply for regular Medicaid health coverage if they are approved for PE-PW?
When beneficiariesapply for PE-PW coverage, they are also applying for regular Medicaid coverage. It is the same application. However, just because they are approved for PE-PW, they may not be approved for full Arkansas Medicaid. After they submit their application, DHS may request further information. It is very important that beneficiariesrespond promptly to all letters from DHS regarding their application. If they do not respond on time, their request for coverage will be denied, and they will be responsible for paying all their labor and delivery costs.
If beneficiaries have regular Medicaid health coverage when their baby is born, will their baby also have regular Medicaid health coverage?
Yes, if beneficiarieshave regular Medicaid health coverage when their baby is born, their baby will also have regular Medicaid health coverage.
If they do not have regular Medicaid health coverage when their baby is born, they will need to apply for coverage for their baby. Again, it is very important that they respond promptly to all letters from DHS regarding their application during their pregnancy, so their baby is covered at birth.
Resources
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Brochure
For more information about Presumptive Eligibility for Pregnant Women, call or visit your local DHS county office.
