Presumptive Eligibility (PE) Programs Manual

1900.020.30 Presumptive Eligibility for Children (PC)

IM#51, May 18, 2017

The Balanced Budget Act of 1997 created Section 1920A of the Social Security Act which gives states the option of providing a period of presumptive eligibility to children (ages 0 through 18) when a qualified entity (QE) determines their family income is at or below Missouri’s applicable Medicaid or CHIP limit. Presumptive Eligibilty for Children (PC) allows these children to receive medical care before they have formally applied for MO HealthNet. House Bill 1111 appropriated funds enabling Missouri to exercise this option.

In addition to the eligibility requirements in section 1900.020.00 , PE determinations for infants and children under age 19 are based upon the following requirements:

  • Household gross income must be at or below 196% of the Federal Poverty Level for children under age 1;  
  • Household gross income must be at or below 150% of the Federal Poverty Level for children between age 1 up to, but not including age 19;
  • There can be no more than one period of PE eligibility within 12-months starting with the effective date of the initial PE period.