Medicaid Presumptive Eligibility and Family Planning Presumptive Eligibility Providers

Attention: All current MPE providers and new medical facilities wishing to become Family Planning and/or MPE providers will need to complete a new 2022 Agreement that incorporates language on FPPE and MPE.  If you are a provider planning to submit an application to become a provider for Family Planning PE, you must submit your new agreement prior to using this new function in ABE. If you do not intend to use this new function you will still need to complete the new agreement, but your deadline to submit the new agreement will be October 1, 2023. To obtain the new agreement send your request to HFS.MPE.FPproviders@illinois.gov .  

The Medicaid Presumptive Eligibility (MPE) Program is one of Illinois' infant mortality reduction initiatives.  Because prenatal care is important in preventing health problems during pregnancy and in promoting newborn health, the program was developed to promote early and continuous prenatal care and to remove financial barriers in obtaining such care. The intent of the MPE program is to provide immediate, limited medical assistance (ambulatory care services only--no inpatient care) to pregnant individuals.  

The Family Planning (FP) Program is a medical program that provides limited medical coverage specifically for reproductive health and family planning related services for eligible Illinois citizens regardless of age or gender. This program can be a default program for those who do not qualify for full Medicaid benefits, or it can be a program of choice for some individuals who may not want full Medicaid coverage. This program has the same income qualifications as MPE/Moms and Babies, but is based on individual, not family income. Presumptive Eligibility (PE) for this program will be determined by MPE providers certified by the Department just as they now determine MPE coverage for pregnant individuals.

Pregnant individuals eligible for MPE, can receive ambulatory medical care that includes prenatal checkups, medically necessary visits to Medicaid enrolled providers, lab tests, prenatal vitamins, prescription drugs, and transportation to and from a source of prenatal medical care.  Also covered is eye care, dental care, and emergency room services. Termination of pregnancy is covered under MPE as well. Because inpatient services (including labor and delivery) are not covered under MPE, it is important that the pregnant woman complete an application for ongoing medical assistance while her MPE coverage is still in effect. Once a woman is determined eligible for ongoing medical assistance (Medicaid) she is provided with a medical card which will cover the full range of Medicaid benefits including hospitalizations and long-term care.

Eligible individuals can receive family planning and related services including an annual exam, family planning counseling, all FDA-approved methods of contraception, permanent methods of birth control (tubal ligation or vasectomy), and basic infertility counseling. Additional covered services include cervical cancer screening and treatment, screening mammograms, BRCA genetic counseling and testing, as applicable, and other testing, treatment, and vaccines for reproductive health. Transportation for family planning visits is also covered.

In accordance with federal requirements, an MPE/FPPE provider enters into, and abides by the terms of the MPE/FPPE Provider Agreement, furnishes services of the type provided by outpatient hospitals, rural health clinics or freestanding maternity clinics and meets one of the following:

• Receives funding under the federal community or migrant health programs under sections 330 and 330A of the Public Health Service Act;
• Receives funding under Title V Maternal and Child Health Block Grant;
• Receives funding under Title V of the Indian Health Improvement Act;
• Participates in the State's perinatal program;
• Receives a grant under the Supplemental Nutrition Program for Women, Infants and Children (WIC);
• Receives a grant under the Commodity Supplemental Food Program under the Agriculture and Consumer Protection Act; or
• Is the Indian Health Service or a health program operated by the tribe or tribal organization under the Indian Self-Determination Act.

MPE/FPPE Providers must:

• Be certified by the Department of Healthcare and Family Services
• Complete an MPE/FPPE Agreement with HFS
  
• Attend department training 

Training Webinars are scheduled as new Providers are enrolled in the MPE and FPPE programs.  Email HFS.MPE.FPproviders@illinois.gov if you have not submitted a new MPE/FPPE Agreement. After completing the new agreement you will be notified for training.

• MPE and FPPE Providers Policy Guide
  
• ABE Guide for MPE and FPPE Providers

• Creating an ABE Provider Portal Account (pdf)
• ABE Agency Security Administrator Job Aid (pdf)
  
• Request for ABE Primary Agency Security Administrator Approval 
• HFS 1706p (pdf)

• There is no reimbursement for completing an MPE and FPPE determination.
• Enrolled providers who provide medical care to MPE or FP eligible individuals will be reimbursed at the current Medicaid rate.
• MPE/FP providers may contact the Bureau of Comprehensive Health Services at 217-782-5565 to obtain rate information for covered services or for billing inquiries.