·     The date which the Agency makes a determination of eligibility for coverage based on an application submitted by the woman

·     If the woman fails to file an application with the agency for coverage, the last day of the month following the month in which the qualified provider made the determination of presumptive eligibility

·         No later than the 60^th day after the qualified provider made the determination of presumptive eligibility

The PEP benefit plan covers the following ambulatory prenatal services:

·         Professional services (e.g. provider office visits, radiology interpretation)

·         Outpatient services (e.g. laboratory studies, radiology studies)

·         Pharmacy services

The PEP benefit plan DOES NOT COVER:

·         Inpatient services

·         Dental services

Qualified providers eligible to become determiners for PEP:

·         Hospitals

·         County Health Departments

·         Federally Qualified Health Centers (FQHCs)

·         Rural Health Clinics (RHCs)

·         Physicians

·         Certified Nurse Midwives (CNMs)

·         Certified Registered Nurse Practitioners (CRNPs)

·         Physician Assistants (PAs)

Eligibility Criteria for PEP:

·         Must be pregnant

·         Must meet income guidelines

o    Income must not exceed the modified adjusted gross income (MAGI) limit for the eligibility for pregnant women which is in effect under the state Medicaid plan

§       Income limits are updated annually and can be found on the Alabama Medicaid website at the following link: Medicaid Eligibility

·         Self-attestation can be accepted for both pregnancy and income verification

To become a qualified provider/determiner:

·         Must complete training provided by Alabama Medicaid

·         Must sign an agreement with Alabama Medicaid

Qualified provider requirements:

·         The qualified provider must notify the Agency within five business days of the determination

·       The qualified provider should inform the patient that she must apply for Medicaid no later than the last day of the following month

o    Online application for Medicaid: insurealabama.adph.state.al.us

PEP and Alabama Coordinated Health Network:

·         Women receiving PEP coverage will not be assigned to an Alabama Coordinated Health Network (ACHN)

·         Women receiving PEP coverage will not require an ACHN referral prior to seeing a maternity care provider for prenatal care

PEP Resources can be found here:  Alabama Medicaid Maternity Website

Questions about PEP can be directed to: pep@medicaid.alabama.gov.