Family Healthcare (FAMIS) Manual

0950.010.05.05 QUALIFIED ENTITY RESPONSIBILITY WHEN CHILDREN FOUND PRESUMPTIVELY ELIGIBLE

If the children (under age 19) are presumptively eligible, the entity will:

  1. Call the MO HealthNet Service Center (1-888-275-5908) to obtain DCNs for the eligible children shown on the IM-1UA and determine if the children have received presumptive eligibility coverage in the last 12 months.
  2. Provide the caretaker with a Presumptive Eligibility Authorization (PC-2) listing the eligible children with a beginning date of eligibility.
  3. Explain the use of Presumptive Eligibility Authorization and the coverage provided. The beginning date is the date of the determination.
  4. Advise the caretaker the MO HealthNet for Kids, Pregnant Women and Parents application will be sent to the local FSD county office for an eligibility determination. Advise the applicant FSD will be contacting them for information, such as income verification, documentation of citizenship/immigration status and health insurance information in order to determine eligibility. Explain that if the family is determined to be ineligible, the presumptive coverage will end on the date of FSD’s determination. The Presumptive Eligibility Authorization will guarantee coverage for a minimum of five days, even if eligibility is not in the MO HealthNet Division’s system on the date of verification. When the children are determined to be eligible or ineligible for ongoing coverage, the family will be notified by FSD.
  5. Fax copies of the PC-1 and PC-2 to the local FSD county office on the date of the presumptive eligibility determination so the presumptive eligibility may be entered in the IMU5 system that same day.
  6. Send the MO HealthNet for Kids, Pregnant Women and Parents application (IM-1UA), Presumptive Eligibility Determination (PC-1) and a copy of the MO HealthNet Presumptive Eligibility Authorization (PC-2) to the local FSD county office the same or next day so that FSD receives it within five working days of the determination.