MedicaidCoverageMedium impact
BT202192: IHCP Presumptive Eligibility benefits, coverage categories and effective dates
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Pediatrics +2 more·Medical Policy
Effective date
Oct 14, 2021
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs updated their Presumptive Eligibility (PE) policy, defining benefit packages, coverage categories, copayment structures, and billing procedures for different PE populations including adults, pregnant women, family planning services, and inmates.
Action Required
Indiana providers: Review PE benefit packages and copayment requirements. Update billing systems to reflect PE Adult copayments ($4 professional/outpatient, $75 inpatient, $4/$8 prescriptions, $8 nonemergency ED). Note COVID-19 copayment suspension remains active. Verify PE coverage limitations for pregnant women (prenatal care only) and family planning services. Contact PresumptiveEligibility@fssa.in.gov for PEPW pregnancy complications.