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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:
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
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