Presumptive Eligibility (PE) Programs Manual

1900.020.80 Adult Expansion Group (AEG-PE)

IM-21 March 3, 2022

Federal statute, 42 U.S.C. 1396a(10)(A)(i)(VIII) and Federal regulation 42 CFR ยง435.119 outline the requirements for states who choose to expand Medicaid.

Emergency rule for 13 CSR 40-7.050 sections (1), (2), and (4) allows qualifying hospitals to make presumptive eligibility (PE) determinations for the Adult Expansion Group (AEG-PE). AEG-PE is for adults, ages 19 through 64, and allows these adults to receive medical care before they have have been formally approved for MO HealthNet.

In addition to the eligibility requirements in section 1900.020.00, PE determinations for AEG are based on the following requirements:

  • Household adjusted gross income at or below 133% of the Federal Poverty Level (FPL). See Appendix A Presumptive Eligibility Income Guidelines.
  • Not entitled to or enrolled in Medicare Part A or B
  • Individuals can only receive PE one time per 12-month period. The 12-month period begins with the date PE previously ended.