The purpose of this memorandum is to introduce new Presumptive Eligibility categories, the new Presumptive Eligibility (PE) Manual, and the following new or revised forms:
- Application for Presumptive Eligibility (PE-1SSL);
- QE Presumptive Eligibility Determination Worksheet (PE-2 Worksheet);
- MO HealthNet Presumptive Eligibility Authorization (PE-3); and
- MO HealthNet TEMP Authorization (PE-3 TEMP);
The Affordable Care Act (ACA) added:
- Presumptive Eligibility for Parents and Caretaker Relatives with a child under age 19, that they have care and control over, living in their household.
- Presumptive Eligibility for Former Foster Youth under the age of 26.
- Presumptive Eligibility for the Show-Me Healthy Babies program.
Presumptive Eligibility Manual Updates
The new Presumptive Eligibility Manual replaces sections 0945.000.00 TEMPORARY MEDICAID DURING PREGNANCY (TEMP) PROGRAM and 0950.000.00 PRESUMPTIVE ELIGIBILITY (PE) FOR CHILDREN PROGRAM from the Family Healthcare Manual (FAMIS). These two FAMIS sections are now obsolete.
This new manual section contains the following updates:
- Adds policy regarding one Temporary MO HealthNet During Pregnancy (TEMP) or Show-Me Healthy Babies (SMHB) determination per pregnancy;
- Adds policy regarding self-attestation for all PE eligibility requirements;
- Replaces references to the obsolete IM-1UA with information regarding ways to apply;
- Advises Qualified Entities (QE) to encourage applicants to apply by telephone or on-line at mydss.mo.gov;
- Advises QEs of performance standards, including encouraging and assisting individuals to apply for regular MO HealthNet by telephone at 1-855-373-9994, through the on-line application at mydss.mo.gov, or with a paper application (IM-1SSL);
- Advises QEs to send applications and other documentation to FSD.MEDES@dss.mo.gov;
- Contact information for QE training requests;
- Adds revised FSD office procedures;
- Adds Appendix A which includes PE income guidelines.
Presumptive Eligibility Form Changes
FSD has created new forms to streamline the presumptive eligibility process.
The chart below shows the forms that are now obsolete as well as the applications and forms Qualified Entities will now use when determining presumptive eligibility:
|IM-1SSL||Application: on-line, IM-1SSL, by telephone, or PE-1SSL|
|PC-1 (Obsolete)||PE-2 Worksheet|
|PC-2 (Obsolete)||PE-3 (proof of coverage for children and parent/caretaker relatives)|
|QP-1 (Obsolete)||PE-1SSL and PE-2 Worksheet|
|QP-2 (Obsolete)||PE-3 TEMP (proof of coverage for TEMP and SMHB)|
FSD will not accept the obsolete forms after April 30, 2017.
All applicants must complete the PE-1SSL application for a presumptive eligibility determination to be made. In addition, QEs have been advised to assist or encourage individuals to apply for regular MO HealthNet.
The Temporary MO HealthNet I.D. Card (QP-2 or TEMP card) is replaced with the MO HealthNet TEMP/SMHB Authorization (PE-3 TEMP) notice.
- Review this memorandum with appropriate staff.
- Do not accept QP-1, QP-2, PC-1, and PC-2 after April 30, 2017
- PE-1SSL Application for Presumptive Eligibility
- PE-2 QE Presumptive Eligibility Determination Worksheet
- Instructions for PE-2 Worksheet.docx
- PE-3 MO HealthNet TEMP/SMHB-PE Authorization
- PE-3 Presumptive Eligibility Authorization