Provider Notice issued 07/17/14

Medicaid Presumptive Eligibility (MPE) and the Obstetric Patient

This informational notice is to remind all providers who care for pregnant women that the Illinois Department of Healthcare and Family Services (HFS) is committed to supporting timely and appropriate prenatal services.

With an influx of new HFS enrollees there have been delays in processing applications. Based on income requirements, Medicaid Presumptive Eligibility (MPE) is meant to provide immediate, temporary coverage for prenatal care pending approval of full benefits under the Moms & Babies program. HFS is very aware of the time sensitivity for pregnant applicants. We are implementing processes to minimize the delays and are working closely with our MPE providers.

The original MPE eligibility period runs from the date the MPE provider finds the woman eligible through the end of the following month. If an application for full benefits is filed before the initial period ends, an extension of MPE coverage will be authorized. While a pregnant woman has MPE coverage, all outpatient/ambulatory services, specialty medical care, supplies, and prescriptions are covered.

All providers should offer the usual and customary care without delay to pregnant patients during the MPE coverage period.

HFS is working to identify pregnant applicants and expediting their application for final determination. Additionally, if patients are near their due date and are still awaiting final determination, please email hfs.aca@illinois.gov with MPE in the subject line for immediate review of the application. In the email, please provide the patient’s application number AND first three letters of first and last name to facilitate the process. If you do not have an application number, please provide the date of birth AND first three letters of first and last name.

Please do not have patients reapply; instead, reassure them that they should continue prenatal care.

Thank you for your patience and continued commitment to providing quality care.

Theresa A. Eagleson, Administrator

Division of Medical Programs