• General Information
  • Introduction
  • Provider Certification
  • Eligibility Criteria
  • Applications
    • Introduction
    • Obtaining Forms
  • Eligibility Verification
  • Duration of Benefits
    • Introduction
    • Extensions
  • Applying for Full-Benefit Medicaid
  • Covered Services
  • Claims
• Appendix
  • Appendix 1 — Instructions for Completing the Presumptive Eligibility for Pregnant Women Application
  • Appendix 2 — Sample Presumptive Eligibility for Pregnant Women Application
• PDF

General Information

Provider Certification

Presumptive eligibility providers determine whether or not a woman qualifies for the PE for Pregnant Women Benefit. The following types of providers may be certified to make PE determinations:

• Clinics that provide prenatal care services.
• Family planning clinics.
• Federally qualified health centers.
• Nurse practitioners.
• Outpatient hospitals.
• Physicians.
• Providers participating in the Special Supplemental Nutrition Program for Women, Infants and Children.
• Rural health clinics.

Providers may be certified to make PE determinations if they provide services typically provided by one of the following:

• Clinics furnished by or under direction of a physician (s. 1905[a][9] of the Social Security Act).
• Outpatient hospitals (s. 1905[a][2][A] of the Social Security Act).
• Rural health clinics (s. 1905[a][2][B] of the Social Security Act).

In addition, providers are required to participate in a program established under one of the following:

• A state perinatal program defined as a physician, nurse practitioner, certified nurse midwife, family planning clinic, outpatient hospital, or other clinic that provides prenatal medical care to Medicaid recipients.
• The Indian Health Services or a health program or facility operated by a tribe or tribal organization (the Indian Self-Determination Act — Public Law 93-638).
• The Special Supplemental Nutrition Program for Women, Infants and Children (s.4(a) of the Agriculture and Consumer Protection Act of 1973).

OR receive funds under one of the following:

• The Community Health Centers or Migrant Health Centers (s. 329 or 330 of the Public Health Act).
• The Maternal and Child Health Services Block Grant Programs (Title V of the Social Security Act).
• Title V of the Indian Health Care Improvement Act.

Providers are required to be Medicaid-certified or have submitted an application for Medicaid certification. Providers may submit their application to become a PE provider with their Medicaid certification application. Providers should refer to the Certification and Ongoing Responsibilities section of the All-Provider Handbook for information about obtaining certification packets and the certification process.

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