Presumptive Eligibility (PE) Programs Manual

1900.020.10 Temporary MO HealthNet During Pregnancy (TEMP)

IM-150 December 29, 2022; IM-178 December 16, 2019; IM-51 May 18, 2017

Temporary MO HealthNet During Pregnancy (TEMP), a Medicaid program mandated by Section 208.151 (12) RSMo (enacted by SB 765 in 1990) began July 1, 1990.

Federal law (Section 1920 of the Social Security Act) and State law refer to this Medicaid coverage as “Presumptive Eligibility”. Family Support Division (FSD) chose to implement the program under the name Temporary MO HealthNet During Pregnancy (TEMP). Staff should be aware of the term “presumptive eligibility” as it relates to the TEMP program to aid in communication with MO HealthNet providers.

The Omnibus Budget Reconciliation Act of 1990 (OBRA ’90), effective July 1, 1991, lengthened the presumptive eligibility (PE) period to give the pregnant woman until the last day of the month following the month she was determined presumptively eligible. It also extends her PE period to the date the state makes the final determination of eligibility on her formal MO HealthNet application. If the formal MO HealthNet application is rejected, the coverage will continue to the last day of the PE period.

The purpose of the TEMP program is to provide early access to prenatal care for pregnant women while they await the formal determination of MO HealthNet eligibility.

NOTE: TEMP provides only ambulatory services (medical care provided on an outpatient basis) while the individual is pregnant.

Services included:

  • physician/clinic;
  • nurse-midwife;
  • diagnostic x-ray and lab;
  • pharmacy; and
  • outpatient hospital services.

Services NOT included:

  • Delivery;
  • D&C’s;
  • inpatient hospital;
  • dental;
  • optical; or
  • any other services which are not Ambulatory Prenatal Services.

In addition to the eligibility requirements in section 1900.020.00 Eligibility Requirements, TEMP determinations are made by a Qualified Entity (QE) based upon the following requirements:

  • Pregnancy;
  • Household gross income must be at or below 196% of the Federal Poverty Level; and
  • There can be no more than one PE eligibility period per pregnancy.

NOTE: A QE may accept self-attestation from the participant that she is pregnant and the number of children expected with the pregnancy.