Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: FILLABLE PDF VERSIONS OF PRESUMPTIVE ELIGIBILITY (PE) FORMS
FORM REVISION #10
The purpose of this memo is to introduce fillable PDF versions of the:
- Qualified Entity Presumptive Eligibility Determination Worksheet (PE-2 Worksheet);
- MO HealthNet Presumptive Eligibility Authorization (PE-3); and
- MO HealthNet TEMP/SMHB-PE Authorization (PE-3 TEMP)
These three forms, along with the previously released Application for Presumptive Eligibility (PE-1SSL) will be made available to all Qualified Entities.
- Review this memorandum with appropriate staff.