Presumptive Eligibility

Presumptive Eligibility (PE) gives people temporary Medicaid coverage while the Iowa Department of Health and Human Services (HHS) reviews their full application. The goal is to make sure those likely to qualify can get care right away.

PE is based on a household’s statements regarding their circumstances and income. A qualified entity* enters the applicant’s information into the Medicaid Presumptive Eligibility Portal to determine if the applicant qualifies. If determined to be eligible, the applicant will have temporary Medicaid eligibility during the PE period.

Individuals who may be eligible for PE include: 

• Children under 19
• Pregnant women
• Parents and caretakers of children under 19
• Adults aged 19-64
• Former foster care children under age 26
• Individuals screened and diagnosed through BCCEDP and needing treatment for breast or cervical cancer

Pregnant women get limited Medicaid coverage for ambulatory prenatal care.

Covered Services

All services are covered that are normally paid by Medicaid when received from an Iowa Medicaid provider. 

Information for Qualified Entities

A Qualified Entity (QE)— usually a certified Medicaid provider—can collect basic information about a person’s income and situation and enter it into the Medicaid Presumptive Eligibility Portal (MPEP). If eligible, the person will get short-term Medicaid during this period.

To become a QE, providers must meet certain requirements and agree to the terms in an electronic agreement (MOU). Once approved, QEs should make sure their organization allows emails from HHS, since that’s how most communication will happen.

Frequently Asked Questions

If you're a Qualified Entity and need answers to common questions for completing a PE application, download our Presumptive Eligibility Frequently Asked Questions (FAQ) brochure.