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4.3.5.4 Medicaid Identification (Form H3087)
A Form H3087 with PE printed on top is issued for PE coverage. Medicaid coverage for PE continues through the last day of the month indicated on the form. Form H3087 with PE indicates that Medicaid-covered services during the PE period do not include labor, delivery, inpatient services, and THSteps medical and dental services. The PE ID indicates eligibility for limited Medicaid services during the PE period (e.g., eye exams, eyeglasses, hearing aids, and family planning services). If the woman is certified for regular Medicaid, she receives the regular Form H3087.
If other members in the family are determined to be eligible for Medicaid, they receive a separate Form H3087 from the one issued to the pregnant woman.
Claims filing procedures for clients with PE are the same as those for all clients with Medicaid.
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