Family Healthcare (FAMIS) Manual – Table of Contents

0945.005.00 LEGAL BASIS AND OVERVIEW

Temporary Medicaid during Pregnancy (TEMP), a Medicaid program mandated by Section 208.151 (13) RSMo (enacted by SB 765 in 1990) began July 1, 1990.  The purpose of the TEMP program is to provide early access to prenatal care for pregnant women while they await the formal determination of MC+ eligibility.

Federal law (Section 1920 of the Social Security Act) and State law refer to this Medicaid coverage as “Presumptive Eligibility”.  This is the name by which many in the health care field commonly refer to this program.  We chose to implement the program under a different name to avoid confusion with our AFDC presumptive eligibility approvals in effect at the time.  Staff should be aware of the term “presumptive eligibility” as it relates to the TEMP program to aid in communication with Medicaid providers.

The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90), effective July 1, 1991, lengthened the presumptive eligibility period to give the pregnant woman until the last day of the month following the month she was determined presumptively eligible, by a qualified provider, to make application for benefits.  It also extends her presumptive eligibility period to the date the state makes the final determination of eligibility on her formal Medicaid application.

OVERVIEW

In the TEMP program, certain designated staff of “Qualified Providers” make limited eligibility determinations for their patients who are pregnant.  If the Qualified Provider determines that a patient meets the income guidelines of the MC+ program, s/he provides the pregnant woman with a Medicaid identification card good through the last day of the month following the month she was determined presumptively eligible.  This card is a pre-numbered form provided by the Family Support Division (FSD).  This number is the woman’s temporary identification number.  The pregnant woman uses this card for any Medicaid covered ambulatory prenatal care service she receives during that time from any Medicaid provider.

In addition, if the pregnant woman makes application for MC+ healthcare coverage with her Family Support Division office by the last day of the second month of TEMP eligibility, the FSD can provide her with additional temporary coverage while the application is pending until FSD makes the final determination on her Medicaid application.  Otherwise, TEMP eligibility ends the last day of the month following the month the pregnant woman was determined eligible for TEMP.

There is no limit on the number of TEMP eligibility determinations a woman can receive during a pregnancy.  TEMP eligibility periods may overlap.