July 3, 2018

Illinois programs for pregnant women: Medicaid Presumptive Eligibility

Think you might be pregnant? Finding out you’re going to have a baby is a joyous time, but it can also be a very stressful time for women with limited income and resources.

But two Illinois programs are available that can be a lifeline for women without insurance coverage. The first one we’ll talk about is the Medicaid Presumptive Eligibility program, commonly referred to as MPE. It’s a state-funded program for pregnant women living in Illinois.

What you should know

Medicaid Presumptive Eligibility is available to women who are pregnant and who meet the income requirements. The program is administered by the Illinois Department of Healthcare and Family Services (IHFS) and part of the All Kids Medical Program. It offers immediate, temporary coverage (less than 60 days) for outpatient healthcare for pregnant women.

Important information to note:

  • You do not have to be a citizen or a legal immigrant

  • You do not have to have a Social Security number

  • There are no premiums or co-payments

How long does it take to get MPE?

If you meet the income requirements for MPE, you can get services right away. That means you can get services the same day you sign the application if the MPE provider says you are eligible. If you have a doctor or clinic, ask the office staff if the doctor or clinic is an MPE provider. If your doctor or clinic is not an MPE provider or if you don’t have a doctor or clinic, contact one of our maternity care clinics to find an MPE provider. Information on MPE providers is also available by calling the All Kids Hotline at 1-866-255-5437.

Once you find a provider, they will confirm you are pregnant and gather income information (gross monthly income for all household members) to determine your eligibility.

How long can I get outpatient services from MPE?

You can get outpatient services starting on the day the MPE provider tells you that you are eligible, until the last day of the next month. For example, if you sign the MPE application on March 1 and the MPE provider says you are eligible, you can get outpatient services from March 1 until April 30. If you sign up on March 31, you can get outpatient services from March 31 until April 30.

What services does MPE cover?

You can get outpatient services like prenatal checkups, doctor visits, lab tests, prenatal vitamins, medicine, specialty medical care, eye care, dental care, emergency room care, mental health and substance abuse services, as well as transportation to medical care and other services.

What doesn’t MPE cover?

You cannot get hospital services, such as labor and delivery, from the MPE program. To get hospital services, you must apply for another Illinois program, called Moms & Babies.