Ohio Presumptive Eligibility for Pregnant Women FAQ: Everything You Need to Know What is Ohio Presumptive Eligibility for Pregnant Women? Presumptive Eligibility for Pregnant Women (PEP) in Ohio is a program designed to provide immediate healthcare coverage for pregnant women who are not currently eligible for Medicaid. PEP allows expectant mothers to receive temporary healthcare benefits while their full Medicaid application is being processed. How does Ohio Presumptive Eligibility for Pregnant Women work? Under PEP, eligible pregnant women can receive immediate coverage for prenatal, delivery, and postpartum healthcare services. Once approved, they can access a comprehensive range of medical care, including doctor's visits, lab tests, ultrasounds, prescription medications, and more. Who can apply for Ohio Presumptive Eligibility for Pregnant Women? Pregnant women who meet the following criteria may be eligible for PEP: 1. Ohio's residents. 2. Pregnant women who are U.S. citizens or qualified immigrants. 3. Women who are not currently eligible for Medicaid or other healthcare coverage. 4. Women whose household income falls within the program's income guidelines. Are there different types of Ohio Presumptive Eligibility for Pregnant Women? Yes, there are two types of PEP in Ohio: 1. Hospital-based PEP: This program allows eligible pregnant women to apply for presumptive eligibility directly at participating hospitals. Once approved, they can receive immediate healthcare coverage and start prenatal care without delays. 2. Qualified Provider Office-based PEP: In addition to hospitals, certain qualified healthcare provider offices can offer presumptive eligibility determination to pregnant women. Eligible women can apply at these locations to receive immediate healthcare coverage while their full Medicaid application is being processed. How long does Ohio Presumptive Eligibility for Pregnant Women coverage last? Once approved, PEP coverage typically lasts for 60 days. During this period, pregnant women can receive prenatal care and other necessary medical services. To maintain continuous healthcare coverage, applicants should complete a full Medicaid application before the end of the PEP coverage period. How can pregnant women apply for Ohio Presumptive Eligibility for Pregnant Women? Eligible pregnant women can apply for PEP in the following ways: 1. Hospital-based PEP: They can apply directly at participating hospitals or prenatal clinics. The staff will help complete the application process and determine immediate eligibility. 2. Qualified Provider Office-based PEP: Visit specific healthcare provider offices offering PEP. The staff will assist in completing the application and verify immediate eligibility. What documents are needed to apply for Ohio Presumptive Eligibility for Pregnant Women? To apply for PEP, pregnant women will need to provide the following documentation: 1. Proof of pregnancy, such as a doctor's statement or ultrasound report. 2. Proof of citizenship or qualified immigrant status. 3. Proof of Ohio residency. 4. Information about household income and assets, including pay stubs, tax forms, or other income verification documents. It's important to note that Ohio Presumptive Eligibility for Pregnant Women aims to ensure pregnant women receive timely and appropriate healthcare services. The program serves as a bridge to temporary coverage until a comprehensive Medicaid application is successfully processed.
Ohio Presumptive Eligibility for Pregnant Women FAQ
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Presumptive Eligibility (PE) is a Medi-Cal program providing immediate, temporary coverage for prenatal services (except delivery, family planning, and optional abortion procedures) to low-income women. PE will cover the cost of these services while the County is processing a woman's Medi-Cal application.
Every year, about 50,000 Ohioans with a disability newly qualify for Medicaid coverage, including individuals with developmental disabilities and mental illness. Today, these Ohioans must prove they are disabled twice, once to receive Supplemental Security Income (SSI) and again to receive Ohio Medicaid benefits.
Medicaid can also deny pregnant women because their household size is too small relative to the total income.
Information through Interactive Voice Response lines at (800) 686-1516.The first response states patient eligibility;The second prompt provides the patient's managed care plan enrollment, if any.
CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage, and works closely with its state Medicaid program.
Pregnant women are usually given priority in determining Medicaid eligibility. Most offices try to qualify a pregnant woman within about 2-4 weeks. If you need medical treatment before then, talk with your local office about a temporary card.
Family Size Monthly Income 1 $1,699 2 $2,289 3 $2,879 4 $3,469 5 $4,059 6 $4,649 7 $5,239 8 $5,829 9 $6,419 10 $7,009 Families with monthly incomes higher than the amount in the first column, but lower than the amount in the second column MUST apply if they do not have private health insurance.
Medicaid and the Children's Health Insurance Program (CHIP) provide no-cost or low-cost health coverage for eligible children in Ohio. These programs provide health coverage for children so that they can get routine check-ups, immunizations and dental care to keep them healthy.
Once approved, how long will Hospital PE Period last? The Hospital PE Period lasts for up to 60 days. The 60-day PE period begins the first day of the month the Hospital PE Application is approved and ends the last day of the following month.
Ohio's statewide Presumptive Eligibility (PE) initiative provides uninsured residents with the opportunity to receive immediate health care services through Medicaid if they are presumed to be eligible.