Family Healthcare (FAMIS) Manual

0950.050.00 PRESUMPTIVE ELIGIBILITY FOR CHILDREN FORMS

IM-1UA — MO HealthNet for Kids, Pregnant Women and Parents application

Presumptive Eligibility Determination form — PC-1

Presumptive Eligibility MO HealthNet Authorization — PC-2

FSD supplies qualified entities with Presumptive Eligibility for Children eligibility determination forms (PC-1), the Presumptive Eligibility Authorization notices (PC-2), and (IM-1UA) MO HealthNet for Kids, Pregnant Women and Parents application. If a qualified entity contacts the county office to request a new supply of Presumptive Eligibility for Children (PC-1 and PC-2), or IM-1UA MO HealthNet for Kids, Pregnant Women and Parents forms, immediately provide the requested forms. Local FSD offices can obtain the (PC-1 and PC-2) forms from IM Program and Policy. The IM-1UA MO HealthNet for Kids, Pregnant Women and Parents application forms are obtained through the warehouse following normal ordering procedures.

The PC-1, PC-2 and IM-1UA forms and instructions are included in the qualified entity training packet and the IM Forms Manual.