Medicaid Eligibility for
  Pregnant Women

How to apply:
There are three ways to apply for pregnancy Medicaid.

• Presumptively Eligible Pregnant Women (PEPW) –   Pregnant women may go to a Qualified Designated Provider (QDP) to receive temporary Medicaid coverage for their prenatal care, usually on the same day they apply.
• Simplified Eligibility for Pregnant Women (SEPW) – Sometimes called MomCare, this process was created in 2001 to allow eligible pregnant women to be approved for full Medicaid coverage quickly and simply.
• ACCESS Florida Application –  If the pregnant woman wishes to receive other benefits, such as cash, food stamps or benefits for other family members, she must complete a “regular” paper ACCESS Florida Application (AFA) or web application.  Normal processing guidelines apply.
  

Application Forms:

• Presumptive Eligibility for Pregnant Women (PEPW): Complete the paper application (Health Insurance Application for Pregnant Woman, CF-ES 2700)
• Simplified Eligibility for Pregnant  Women (SEPW): Complete the paper application ((Health Insurance Application for Pregnant Woman, CF-ES 2700))
• Other Medicaid, including Medically Needy: Complete either the electronic (WEB-APP) or paper ACCESS Florida application (AFA)
  

Where to Apply:

• Presumptive Eligibility for Pregnant Women (PEPW): At a Qualified Designated Provider (QDP).
• Simplified Eligibility for Pregnant Women (SEPW): At a DCF ACCESS office in person, by mail or by fax.
• Other Medicaid, including Medically Needy: At a DCF ACCESS office in person, on-line, by mail or by fax.
• County Public Health Units (CPHU) (aka: County Health Departments): See listings Florida Department of Health
• Children’s Medicaid Services (CMS): See listings CMS Programs -- Children's Medical Services Homepage
• Regional Perinatal Intensive Care Centers (RPICC) (i.e., certain designated regional hospitals): See listings CMS RPICC Family Brochure Information
  

Required Verification:

• For Presumptive Eligibility for Pregnant Women (PEPW):
     Proof of pregnancy from a medical provider.
     Verbal Statement of Income
• For Simplified Eligibility for Pregnant  Women (SEPW):
     Proof of pregnancy from a medical provider.
     Proof of citizenship and identity for US citizens.
     Proof of non-citizen status for non-citizens.
     Proof of self-employment income
     Other verifications, such as a Social Security Number.
• For other Medicaid, including Medically Needy:
     Proof of pregnancy from a medical provider.
     Proof of citizenship and identity for US citizens.
     Proof of non-citizen status for non-citizens.
     Proof of income and assets for all household members.
    

Extent of Medicaid Coverage:

• Presumptive Eligibility for Pregnant Women (PEPW) – Limited Coverage:
     Covers the pregnant woman only.
     Covers pregnancy related outpatient services and prescriptions only.
     Only one presumptive period per pregnancy allowed.
• Simplified Eligibility for Pregnant  Women (SEPW) – Full Coverage:
     Covers the pregnant woman only.
     Covers all Medicaid services, including inpatient services and delivery.
• Other Medicaid, including Medically Needy – Full Coverage:
     Covers all Medicaid services for all eligible household members, if requested.
  

Duration of Medicaid Coverage:

• Presumptive Eligibility for Pregnant Women (PEPW)
  Begins the date of application and lasts until DCF makes a determination of ongoing eligibility, or 60 days (whichever is less).
• Simplified Eligibility for Pregnant  Women (SEPW)
  Begins the first day of the application month and lasts through two (2) post-partum months. Lasts up to three (3) months retroactive coverage available, if eligible and requested, provided woman was pregnant during the retroactive period.
• Other Medicaid, including Medically Needy
  Other Medicaid:  Begins the first day of the application month and lasts through two (2) post-partum months.
• Medically Needy:  Begins the date that Share of Cost is met.
  Up to three (3) months retroactive coverage available, if eligible and requested.
  

U.S. Citizenship and Identity Verification Policy for Medicaid

• This policy does not apply to PEPW
• Most individuals who indicate they are U.S. citizens on the application must provide verification of their citizenship and identity.
• Exceptions:  Individuals who are…
  • SSI recipients
  • Social Security Disability (SSDI) recipients
  • Children in state foster care or adoption
  • Medicare (any part) recipients
  • Medicaid cannot be authorized prior to receipt of verification
  • For a list of acceptable verification documents go to:http://www.dcf.state.fl.us/ess/docs/dra_verify.pdf