Note: County jails interested in participating in the Presumptive Eligibility for Inmates (PE for Inmates) process should send an email to email@example.com.
The PE for Inmates process allows acute care hospitals that are qualified providers (QPs) for Presumptive Eligibility (PE) to enroll eligible inmates into the Indiana Health Coverage Programs (IHCP) for temporary coverage of authorized inpatient hospitalization services.
PE for Inmates is available to individuals who meet the following requirements. The individual must:
- Be an inmate from a correctional facility operating under the memorandum of understanding or contract with the Indiana Family and Social Services Administration (FSSA)
- Not be on house arrest
- Not be pregnant or admitted for labor and delivery
- Be admitted for inpatient hospitalization
- Be under the age of 65
- Meet all other standard PE requirements
Inmates who go through the PE process must complete an Indiana Application for Health Coverage to retain inpatient benefits. Individuals who complete applications and are found eligible will be covered for 12 months under the Medicaid Inpatient Hospital Services Only benefit plan. If the inmate does not complete an Indiana Application for Health Coverage, the Eligibility coverage will end on the last day of the month following the month in which the individual was found presumptively eligible. If individuals remain incarcerated after one year, they may reapply for coverage through the PE for Inmates process.
Services rendered to individuals covered under Medicaid Inpatient Hospital Services Only (through the PE for Inmates process) will be reimbursed through the fee-for-service (FFS) delivery system at FFS rates. Providers are reminded to always verify individuals' eligibility before rendering services. Eligibility can be verified by using any of the following Eligibility Verification System (EVS) options:
- IHCP Provider Healthcare Portal
- Interactive virtual assistant (GABBY) on the IHCP Customer Assistance line (800-457-4584, Option 2)
- Electronic Data Interchange (EDI) 270/271 – Eligibility Benefit Transaction
More information about PE for Inmates is available through the following links:
- PE for Inmates Training Presentation (Hospitals)
- Medicaid for Incarcerated Individuals Training Presentation (Correctional Facilities)
- Frequently Asked Questions Regarding Medicaid and Inmates
- The Presumptive Eligibility provider reference module
Additional questions or concerns may be emailed to firstname.lastname@example.org.