By Erinn Funches, MCJ Community Organizer, Health Justice
Access to prenatal care ensures the health of both mother and baby during pregnancy. However, many expectant mothers face barriers in getting the care they need early in pregnancy, especially if the mother is uninsured and/or awaiting Medicaid application approval. This is where Presumptive Eligibility comes in.
Mississippi’s Presumptive Eligibility for Pregnant Women (PEPW) allows eligible individuals to receive 60 days of outpatient prenatal care before their Medicaid application is fully processed, improving access to care for low-income pregnant individuals. To qualify, you must be pregnant, a U.S. citizen or eligible immigrant, not have current Medicaid coverage, and have a household income at or below 194% of the Federal Poverty Level.
You can get this temporary coverage by contacting a qualified provider, such as a doctor or health clinic, who will determine your eligibility based on preliminary income information. The PEPW provision permits qualified providers to immediately deem presumptively eligible pregnant women to be temporarily eligible for limited Medicaid benefits. You must still complete a full Medicaid application to continue receiving care beyond the initial presumptive period.
Presumptive eligibility is a vital policy tool in closing the gaps in maternal care access. It eliminates barriers caused by insurance status, income, and delays in Medicaid applications—ensuring that no woman or unborn child is left waiting for essential care. Every mother and baby deserves timely and quality healthcare without the burden of inequity.
If you have questions regarding presumptive eligibility, please contact Erinn Funches, Health Justice Community Organizer at efunches@mscenterforjustice.org.
- PEPW is a process where a qualified provider makes a fast determination of Medicaid eligibility for pregnant women.
- This allows for immediate access to outpatient prenatal care while the full Medicaid application is pending, helping to close the gap in care.
Who Qualifies?
- You must be pregnant.
- You must have not received PEPW for current pregnancy yet.
- Your total family income must be at or below 194% of the Federal Poverty Level.
- You must not already have Medicaid coverage.
- You must be a U.S. citizen, U.S. national, or an eligible immigrant.
How to Apply:
- Contact your healthcare provider.
Share Your Story
At the Mississippi Center for Justice, we are committed to protecting and advancing women’s health by advocating for access to affordable, comprehensive, and compassionate care. Our focus is especially on improving health outcomes for women of childbearing age in Mississippi. If you or someone you know would like to share your experience navigating prenatal care in Mississippi, please complete this form.
Read the introductory blog to this series:
Introducing IMPACT Mississippi and Maternal Health Blog Series