Presumptive Eligibility

Presumptive eligibility (PE) provides Medicaid for a limited time while a formal Medicaid eligibility determination is being made by the Iowa Department of Health and Human Services (HHS). The goal of the presumptive eligibility process is to offer immediate health care coverage to people likely to be Medicaid eligible, before there has been a full Medicaid determination. Based on a household’s statements regarding their circumstances and income, a qualified entity (QE) can enter the applicant’s information into the Medicaid Presumptive Eligibility Portal (MPEP). If determined to be eligible, the applicant will have temporary Medicaid eligibility during the presumptive eligibility period. A “qualified entity” or QE is generally defined as an enrolled Iowa Medicaid provider who is certified by HHS and is authorized to make presumptive eligibility determinations. A provider who meets the QE requirements must agree to the terms and conditions in an electronically maintained Memorandum of Understanding (MOU).

 

Once registered as a Qualified Entity (QE), the QE should ensure with their organization that emails from HHS will not be blocked by their organization's firewall. Emails will be the primary source of communications between the QEs and HHS.

 

Medicaid Presumptive Eligibility Portal (MPEP)
The Medicaid Presumptive Eligibility Portal (MPEP) is a self-service portal that is used by an approved qualified entity (QE) for presumptive Medicaid eligibility determinations.


General Information:

For Members: 

For Providers:

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