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Medicaid Presumptive Eligibility

The Medicaid Presumptive Eligibility (MPE) program is for pregnant women. Under MPE, pregnant women can get immediate outpatient services for a limited time. Eligibility for the program is based on a medically verified pregnancy and the pregnant woman's statement of her family's gross monthly income. Only qualified providers can determine eligibility for the MPE program.

MPE Provider Qualifications

In accordance with federal requirements, only organizations that receive funding under one of the following programs can be a MPE provider.

  • Federal community or migrant health programs (Section 329, 330 or 340 of the Public Health Service Act)
  • Title V Maternal and Child Health Block Grant

  • Title V of the Indian Health Improvement Act

  • Title XIX (Medicaid) or Title XXI (SCHIP) for prenatal services

  • The Indian Health Service or a health program operated by a tribe or tribal organization under the Indian self-determination

 In addition, MPE providers must

Be enrolled in the Illinois Medicaid program

              • Deliver outpatient hospital services, clinic services, or rural health care as defined by Title XIX of the Social Security Act

How to Become a MPE Provider

 MPE providers must:

          • Be certified by the Department of Healthcare and Family Services

          • Have a MPE agreement with the department

          • Attend department training

Organizations that meet the above qualifications and are interested in becoming a MPE provider should fax a request to the Bureau of All Kids at 217-557-5801.

 

MPE Provider Reimbursement

  • There is no reimbursement for completing a MPE determination.
  • Enrolled providers who provide medical care to MPE eligible women will be reimbursed at the current Medicaid rate.

  • MPE providers may contact the Bureau of Comprehensive Health Services at 217-782-5565 to obtain rate information for covered services or for billing inquiries

 


Provider Programs

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director