Effective October 1, 2025, Presumptive Eligibility for Pregnancy (PEP) allows pregnant women who meet requirements to receive temporary Maternity coverage through the Alabama Medicaid Agency (Medicaid). This coverage begins immediately once a qualified provider makes the determination.
PEP was authorized by Senate Bill 102 (Act 2025-204), passed during the 2025 legislative session.
Training for Providers
Only qualified providers may make PEP eligibility determinations. Completion of Alabama Medicaid Agency training is required.
To request training or to ask questions, email PEP@medicaid.alabama.gov.
PEP coverage starts on the day a qualified provider determines eligibility and ends on the earliest of:
- The date Medicaid makes a decision on the woman's full application, or
- The last day of the month following the month in which PEP determination was made (if no Medicaid application is filed), or
- No later than the 60th day after the PEP determination
Qualified providers include:
- Hospitals
- Federally Qualified Health Centers (FQHCs)
- Rural Health Centers (RHCs)
- County Health Departments
- Physicians
- Certified Nurse Midwives
- Certified Registered Nurse Practitioner
- Physician Assistants
A pregnant woman may be determined presumptively eligible if:
- She provides proof of pregnancy
- She provides monthly household income documentation
- Her household income does not exceed Medicaid's MAGI income limits for pregnant women
Qualified providers may determine a pregnant woman to be presumptively eligible for coverage for ambulatory prenatal care under Medicaid if they determine on the basis of preliminary information that household income does not exceed the modified adjusted gross income (MAGI) limit for the eligibility of pregnant women which is in effect under the state Medicaid plan.
Eligibility income Guidelines: Medicaid Income Limits
Provider Responsibilities:
- Determine PEP eligibility based on pregnancy status and income.
- Notify Medicaid of your determination within 5 business days.
- Inform patients that they must complete a full Medicaid application no later than the last day of the following month that PEP coverage began.
- Encourage patients to apply for Maternity Care coverage right away to avoid a gap in coverage. Patients can apply online at: https://insurealabama.adph.state.al.us/
Covered Services:
- Professional claims
- Outpatient claims
- Pharmacy claims
Not Covered:
- Inpatient hospital claims
- Dental claims
Important: Claims must include a pregnancy diagnosis.
Note: PEP recipients will not be assigned to an ACHN and will not be required to get an ACHN referral.