Presumptive Eligibility (PE)

Accuracy is key when completing PE applications – We can help.

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.

Qualified Providers are allowed to assist individuals in completing the online application at their facility and may designate entities to complete the process on their behalf.  The application is available 24 hours a day through Web InterChange and requires answers to questions regarding demographics, family size, and income.

Providers receive real-time presumptive eligibility determinations and if approved, the individual receives immediate, temporary coverage, reimbursed on a fee-for-service or managed care basis.  Individuals are then required to complete a full Indiana Application for Health Coverage in order to keep the coverage.

Providers must enroll and notify the FSSA of their intent to receive presumptive eligibility determinations and will be monitored to ensure that specific performance standards, set by the FSSA, are met.

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.

  • 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