Presumptive Eligibility (PE) Programs Manual

1900.020.80 Adult Expansion Group (AEG-PE)

IM-150 December 29, 2022; IM-21 March 3, 2022

Federal statute, 42 U.S.C. 1396a(10)(A)(i)(VIII) and Federal regulation 42 CFR §435.119 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 AEG-PE. AEG-PE is for adults, ages 19 through 64, and allows these adults to receive medical care before they have been formally approved for MO HealthNet.

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

  • The individual is not pregnant or eligible for PE for Pregnant Women (either TEMP or SMHB-PE).
  • The individual is not eligible for PE for Parents/Caretaker Relatives (MHF-PE).
  • The individual is not eligible for PE for Former Foster Care Youth (FFCY-PE).
  • Household adjusted gross income at or below 133% of the Federal Poverty Level (FPL). See Presumptive Eligibility Income Guidelines (Appendix A – PE Income Standards).
  • 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.