Closing Presumptive Eligibility and Alternative Care

Presumptive Eligibility (PE) must be closed upon approval or denial of ongoing full MO HealthNet (MHN) coverage.

Alternative Care (AC) must be reviewed through Children’s Division (CD) on a case-by-case basis prior to approval or rejection of MHN coverage. Requests should not be sent until all verifications are in place to approve coverage

Staff should check to see if a participant has PE/AC coverage by reviewing MXIX and comments on the Client Contact Notes in MEDES.   When a participant with an active PE/AC case is ready to be approved or denied for ongoing MHN, please follow these directions to close the PE/AC case.

NOTE: Currently Presumptive Eligibility (PE) applications and associated actions are ONLY being handled by the Jefferson City Processing Center, however staff processing ongoing applications need to take actions to the PE.

AEG-PE AND MHF-PE #

PE for the Adult Expansion Group (AEG-PE/ME E2) and PE for Parent & Caretaker Relative (MHF-PE/ME 05) can be identified by the Type of Coverage (TOC) on MXIX showing a “P” to indicate PE coverage.

• • If an applicant has active AEG-PE or MHF-PE, and you are ready to approve or deny the ongoing coverage, finalize the ongoing coverage.
    • • Approving the ongoing coverage in MEDES will close the AEG-PE or MHF-PE cases automatically overnight.
      • Cases that are denied will need a bypass submitted by field staff to close the AEG-PE or MHF-PE beginning immediately.

Submitting a bypass through the Missouri Incident Tracking System (MITS) to end the presumptive eligibility coverage. 

• • Create a new Incident Report with the subject General-Bypass for Coverage Outside of MEDES.
  • The description when creating the bypass is to close PE.
  • Once the ticket is created, submit a bypass.
  • The reason for the bypass is No PDC, the type of bypass is Coverage Change, and the Type of Case is Presumptive Eligibility.
  • The application date and coverage begin date are the date the coverage started on MXIX. The certification date and coverage end date are the date the bypass is submitted.

TEMP, SMHB-PE AND PRESUMPTIVE ELIGIBILITY FOR CHILDREN #

Other PE programs are in the Legacy system so a manual end date for PE must be entered by MO HealthNet (MHN) Program and Policy.

ME 58

• • If an applicant has active Temporary MO HealthNet During Pregnancy (TEMP), and you are ready to approve the ongoing coverage, send an email to FSD.IM.COLE.PE@dss.mo.gov with “Close PE” in the subject line prior to finalizing the full MO HealthNet coverage. Include the following information in the email:
    • • Name of the individual;
      • DCN
      • Type of PE the participant shows active.

Note:  If determined ineligible for regular MO HealthNet coverage, ME 59 coverage will continue until the end of the PE period.

ME 87 and ME 94

• • If an applicant has active Presumptive Eligibility for Children (PC) or Show-Me Healthy Babies Presumptive Eligibility (SMHB-PE), finalize to approve or deny the ongoing coverage, then send an email to FSD.IM.COLE.PE@dss.mo.gov with “Close PE” in the subject line.  Include the following information in the email:
    • • Name of the individual;
      • DCN
      • Type of PE the participant shows active.

BCCT-PE ME 83 and ME 84

• • If applicant has active BCCT-PE and they qualify for another level of coverage, finalize to approve ongoing coverage then send an email to FSD.IM.COLE.PE@dss.mo.gov with “Close PE” in the subject line. Include the following information in the email:

• • • • Name of the individual;
      • DCN
      • Type of PE showing active.

AC #

ME 07, ME 08, ME 36, ME 37, ME 38, ME 50, ME 52, ME 56, ME 57-AC can be identified by the System (SYS) on MXIX showing a “AC” to indicate AC coverage.

• • If an applicant has active AC, and you are ready to approve the ongoing coverage, prior to finalizing full MHN coverage, send an email to COLE.MHNPOLICY@dss.mo.gov with “AC closure for ME (select the appropriate ME #)” in the subject line. Include the following information in the email:
    • • Name of the individual(s)
      • DCN
      • Physical Address
      • Mailing Address (only if different from physical address)
      • Phone Number (if provided)
      • Level of FSD coverage ready to approve
      • Date of application, the head of household (HOH), and HOH DCN
  •  Pause task in Current with reason- Agency Action Required. State office staff will review the case for the correct level of care. Allow ample time for communication with other divisions. An email will be sent to the original requestor with the results.
  • Once the response is received, FSD approvals should be completed within 2 business days. Ensure Managed Care updates in the overnight batch.

HOH Person Page Case Comment #

PE Closure:

• • Note Subject: Presumptive Eligibility Case Closure
  • Note Body: Enter information stating when the Presumptive Eligibility case was closed and why.

AC Closure: 

• • Note Subject: Alternative Care Case Closure Request
  • Note Body: Enter information stating when the request to close AC was sent and why.