Presumptive Eligibility for Pregnant Women
House Bill 539, approved by the Mississippi Legislature during the 2024 regular session, authorized the Mississippi Division of Medicaid to offer presumptive eligibility for pregnant women (PEPW) to provide coverage for ambulatory prenatal care.
What is Presumptive Eligibility for Pregnant Women?
The PEPW provision permits qualified providers to immediately deem presumptively eligible pregnant women to be temporarily eligible for limited Medicaid benefits.
To make PEPW determinations, a provider must:
- Participate as a Medicaid provider.
- Be an OB/GYN, primary care provider, Federally Qualified Health Center, Rural Health Clinic, or Mississippi Department of Health employee.
- Submit a qualified provider application to PE.PregnantWomen@Medicaid.MS.gov
- When approved, submit an executed Memorandum of Understanding.
- Agree to make PEPW determinations consistent with Medicaid’s policies and procedures.
- Not be disqualified from making PE determinations for failure to meet performance standards.
How PEPW Works to Get People Connected to Coverage and Care
PEPW is aimed at improving individuals’ access to Medicaid and covered services by providing another channel to apply for coverage.
- It ensures the qualified provider will be reimbursed for ambulatory prenatal services provided, just as if the individual was enrolled in standard Medicaid.
- PEPW is not about short-term coverage; it provides individuals with an opportunity to get connected to longer-term coverage options by submitting a full Medicaid application.
Staff Eligible to Make PEPW Determinations
Once a provider is notified they have been deemed a qualified entity:
- Designated employees must be properly trained and certified to make PEPW determinations.
- Only the employees that have been trained and certified may make PEPW decisions.
– Posted June 28, 2024
June 28, 2024
