Presumptive Eligibility (PE) Programs Manual

1900.020.20 Show-Me Healthy Babies Presumptive Eligibility (SMHB-PE)

IM#51, May 18, 2017

Section 2112 of the Social Security Act authorized states to offer coverage under the Children’s Health Insurance Program (CHIP) for uninsured pregnant women. Senate Bill 716 (2014) established the Show-Me Babies (SMHB) program for uninsured pregnant women:

  • whose income is above the MO HealthNet for Pregnant Women (MPW) maximum; and
  • who are uninsured and do not have access to affordable coverage.
    • A pregnant woman with insurance which does not inclue pregnancy related services is considered uninsured and eligible for SMHB-PE.

In addition to the eligibility requirements in section 1900.020.00, SMHB-PE determinations are made by QE based upon the following requirements. The parent of an unborn child must:

  • Be pregnant;
  • Have household gross income above 196% of the Federal Poverty Level (FPL)and at or below 300% of the FPL; and
  • There can be no more than one PE eligibility period per pregnancy.

    NOTE: SMHB-PE 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