Presumptive Eligibility (PE)

Presumptive Eligibility is a category of assistance offered through The Indiana Health Coverage Programs (IHCP) by which individuals can be determined presumptively eligible and receive temporary health coverage until the FSSA determines official eligibility.

Here are some highlights of the program:

  • Qualified Providers, such as, acute care and psychiatric hospitals, are allowed to assist individuals in completing the online application at their facility. The application is available 24 hours a day through the IHCP Provider Healthcare Portal and requires answers to questions regarding demographics, family size, and income.
  • Once the application is submitted, the provider receives a real-time presumptive eligibility determination.   If approved, the individual receives immediate, temporary coverage, reimbursed on a fee-for-service or managed care basis.
  • The temporary coverage remains active until the last day of the month following the month of enrollment. An individual must complete a full Indiana Application for Health Coverage in order to possibly keep the coverage longer.
  • Providers must enroll and notify the FSSA of their intent to receive presumptive eligibility determinations. Providers will be monitored to ensure that specific performance standards, set by the FSSA, are met in regards to the PE process.  Providers may designate entities to complete the process on their behalf and that is where ClaimAid comes in.
  • Groups eligible for PE coverage include:
    • Low-income infants and children
    • Low-income adults
    • Former foster care children
    • Low-income pregnant women
    • Individuals seeking family planning services only
    • Inmates

ClaimAid Patient Advocates are certified Indiana Navigators trained to screen patients for eligibility and complete both the PE and full application for health coverage if appropriate.  Let our advocates explain the options to your patients, complete the application, and submit necessary documents in order to receive a determination.  We are your trusted partner in improving your revenue cycle while focusing on patient satisfaction.