Presumptive Eligibility Medicaid for Pregnant Women

Presumptive Eligibility (PE) is for low-income pregnant women. It is a program designed to provide immediate, temporary coverage of ambulatory prenatal care services to pregnant women while their eligibility for full Medicaid benefits is determined.

Ambulatory prenatal care includes all Medicaid-covered services except inpatient hospital care and services associated with the delivery of the baby. You must follow through with the process to determine if you are eligible for full Medicaid benefits.

PE may be granted to a woman if she meets the following criteria:

• is pregnant
• is a Nebraska resident
• meets income guidelines
• has not been previously granted PE for the current pregnancy

When you come in to complete the application for PE, we will help you find a prenatal medical provider. If you have not made an appointment, we will help you make one.

Your coverage will begin on the day that you complete your PE application. However, you must follow through with the process to determine if you are eligible for full Medicaid benefits.

We will mail your application for full Medicaid benefits to DHHS within the next 1-2 days. You will be contacted by DHHS within the next 2-4 weeks about your application. DHHS may contact you by letter or they may call you to schedule an appointment to review your application. If you do not hear from them in 3-4 weeks, you need to contact them to check on the status of your application. Call DHHS at 402-323-7455.

Remember, approval for presumptive eligibility is not the same as being approved for Medicaid. Your PE coverage is only temporary while your eligibility for full Medicaid benefits is determined.

It is very important that you respond promptly to all requests for information from the state regarding your Medicaid application. The costs of your continuing prenatal care, as well as labor and delivery costs, will only be covered if you are approved for full Medicaid benefits.

Lincoln-Lancaster County Health Department is an approved qualified provider of presumptive eligibility. Call 402-441-8065 for income guidelines and an appointment.