Temporary Medicaid during Pregnancy (TEMP), a Medicaid program mandated by Section 208.151 (13) RSMo (enacted by SB 765 in 1990) began July 1, 1990. The purpose of the TEMP program is to provide early access to prenatal care for pregnant women while they await the formal determination of MC+ eligibility.
Federal law (Section 1920 of the Social Security Act) and State law refer to this Medicaid coverage as “Presumptive Eligibility”. This is the name by which many in the health care field commonly refer to this program. We chose to implement the program under a different name to avoid confusion with our AFDC presumptive eligibility approvals in effect at the time. Staff should be aware of the term “presumptive eligibility” as it relates to the TEMP program to aid in communication with Medicaid providers.
The Omnibus Budget Reconciliation Act of 1990 (OBRA '90), effective July 1, 1991, lengthened the presumptive eligibility period to give the pregnant woman until the last day of the month following the month she was determined presumptively eligible, by a qualified provider, to make application for benefits. It also extends her presumptive eligibility period to the date the state makes the final determination of eligibility on her formal Medicaid application.
OVERVIEW
In the TEMP program, certain designated staff of “Qualified Providers” make limited eligibility determinations for their patients who are pregnant. If the Qualified Provider determines that a patient meets the income guidelines of the MC+ program, s/he provides the pregnant woman with a Medicaid identification card good through the last day of the month following the month she was determined presumptively eligible. This card is a pre-numbered form provided by the Family Support Division (FSD). This number is the woman's temporary identification number. The pregnant woman uses this card for any Medicaid covered ambulatory prenatal care service she receives during that time from any Medicaid provider.
In addition, if the pregnant woman makes application for MC+ healthcare coverage with her Family Support Division office by the last day of the second month of TEMP eligibility, the FSD can provide her with additional temporary coverage while the application is pending until FSD makes the final determination on her Medicaid application. Otherwise, TEMP eligibility ends the last day of the month following the month the pregnant woman was determined eligible for TEMP.
There is no limit on the number of TEMP eligibility determinations a woman can receive during a pregnancy. TEMP eligibility periods may overlap.
A Qualified Provider is a Medicaid enrolled provider determined by the Family Support Division to meet qualifications necessary to make TEMP eligibility determinations. Qualified providers are required by law to be providers who receive funds from specific federal programs. Generally, qualified providers are limited to County Health Departments and health clinics that participate in required federal programs. A listing of the Qualified Providers currently enrolled is located in Appendix A of this section.
Qualified Provider responsibilities are detailed in the Qualified Provider Manual, which is issued to each Qualified Provider. Each county office has one Qualified Provider Manual.
The qualified provider is responsible for screening all pregnant women who come to the provider for services to see if they are interested in healthcare coverage.
If the pregnant woman wants healthcare coverage, the qualified provider will:
It is the responsibility of the FSD county office to:
If the QP has made errors in determining income eligibility or the dates on the TEMP card are incorrect, the county TEMP liaison immediately discusses these problems with the SP designated staff.
If the claimant subsequently applies for MC+, incorporate the TEMP section into the MC+ case record.If the claimant does not subsequently apply for assistance, maintain this case record for five years following the ending eligibility date.
Local FSD office procedures must ensure that TEMP case records are readily available for review by intake caseworkers when TEMP claimants apply for MC+.
There are two ways to identify TEMP eligible women at the application interview:
- Screening on IPAR prior to the application interview may indicate TEMP eligibility. Provide this information to the worker prior to the interview.
- TEMP eligible women are identified if they present a current TEMP identification card (QP-2).
EXCEPTION: If you know at the time of application that the woman is not eligible for MC+, do not give her an IM-29(TEMP) letter. If you do not give her a letter, you must reject her application before the end of the TEMP eligibility period.
When the MC+ is entered via IAPP, the system automatically extends TEMP coverage to the 15th day of the MC+ application.
This process occurs only if a MC+ is not acted upon within 15 days, or by the end of the TEMP eligibility period, whichever is later. It should not happen frequently.
When an application for MC+ is pending for a TEMP eligible woman, the system tracks the application in relation to the TEMP eligibility. On the last day of TEMP eligibility, if a MC+ application is pending, the system generates a message to the worker on the print subsystem. The message states, “Make a decision on the above Medicaid application today, or send a letter extending TEMP eligibility to MM/DD/YY”. If you are unable to make an eligibility decision on the date of this message, send an IM-29(TEMP) letter to extend TEMP eligibility seven additional days. (The seventh day is listed on the message.) If no action is taken on the MC+ application on the date of the message, the system extends TEMP eligibility seven days.
Every seven days, this process is repeated until the MC+ application is completed. Every time the extension message is generated, the worker must send an IM-29(TEMP) or complete the application that day.
NOTE: Be sure to mail the IM-29(TEMP) the same day as the extension message, so the woman has continuous proof of TEMP coverage.
TEMP Eligibility Determinations Forms - QP-1
Temporary I.D. CARDS - QP-2
State Office supplies Qualified Providers with TEMP eligibility determination forms, QP-1, and pre-numbered TEMP Temporary Medicaid I.D. cards (QP-2). State Office keeps controls on which temporary numbers are assigned to each Qualified Provider. If Qualified Providers contact the county office to request a new supply of QP-1 forms or QP-2 cards, immediately forward the request to State Office, Income Maintenance Section.
The number printed on the card serves as a temporary Medicaid number for the client. It is the number providers use to bill for medical services provided during the TEMP eligibility period.
When a TEMP eligible woman applies for MC+, use the completed QP-1 form as verification of pregnancy.
The QP-1 form, TEMP card (QP-2), and instructions are included in the Qualified Provider Manual and the IM Forms Manual.
When Qualified Providers send form QP-1 and QP-2 to the FSD office to notify of TEMP approvals, enter the information into the TIMP screen. Complete instructions for the ITMP screen are included in the IM Forms Manual in the QP-Instructions.
NOTE: Do not enter the Social Security Number as it has not been verified. Record the DCN on the QP-1.
The information in the ITMP system is used by the IM system to do several tasks:
If an application is still pending on the 15th day, the system sends a message on the print subsystem. The message states, “Make a decision on the above Medicaid application today, or send a letter extending TEMP eligibility to MM/DD/YY”.
On the evening of the 15th day, the system checks for a rejection or approval. If neither is found, eligibility is extended on ITMP for an additional seven days by the system.
Every seven days, the system continues this procedure. On the seventh day of the extension, print subsystem messages are generated; if no action is taken, the system extends for an additional seven days. This procedure repeats until the application is processed.
NOTE: If the seventh day falls on a weekend or holiday, the seventh day will be the last working day before the weekend or holiday. (The same applies to the 15th day after application).
TEMP claimants do not have hearing rights regarding TEMP decisions made by Qualified Providers or ending dates of TEMP coverage. Qualified Providers must always inform TEMP applicants of their right to have a formal determination of eligibility with their local FSD office. TEMP claimants have the right to hearings regarding any regular MC+ eligibility determination made by FSD.
Healthcare benefits for TEMP recipients are more limited in scope than regular MC+ benefits. TEMP Medicaid coverage is restricted to services for “ambulatory prenatal care”. This means that for TEMP recipients, healthcare coverage pays only for services which are related to the pregnancy and provided on an outpatient basis. For example: In a doctor's office, clinic, or outpatient hospital setting, including diagnostic testing; or from a pharmacy. Delivery is not a covered service under the TEMP program.
While the woman must obtain their TEMP determinations from a Qualified Provider once TEMP eligible, they can obtain services from any Medicaid/MC+ provider, subject to the limitations listed above.
TEMP claimants are not regular MC+ recipients. Thus, children born to TEMP only claimants are not eligible for MC+ coverage under the Newborn policy. If, at the time of birth, the TEMP claimant has already been approved for regular MC+ by FSD, the child qualifies for MC+ as a newborn.
A TEMP eligibility period has no effect on the beginning eligibility date of regular MC+ coverage. Explore prior quarter coverage in the same manner as for any application. TEMP eligible women who are subsequently approved for MC+ will have overlapping periods of coverage; however, MC+ under a regular IM program covers a much broader range of services than the limited coverage under the TEMP program. Thus, take no action to avoid these overlapping periods.
The terms of the Qualified Provider Agreement specify that designated staff may not make TEMP eligibility determinations prior to attending required training. Additionally, Qualified Providers must notify State Office in writing of any changes in designated TEMP staff.
Initially, the Staff Training units were responsible for training Qualified Provider staff.
Area and county office staff have responsibility for ongoing training of Qualified Provider staff. Additional providers may wish to enroll as Qualified Providers at a later date. The providers must sign Qualified Provider Agreements with FSD State Office. Designated area/county staff will set up sessions to train the staff of these providers. If you receive requests from providers who want to become Qualified Providers, contact State Office, Income Maintenance Section. The enrollment and training will need to be coordinated between the provider and FSD State Office and area/county staff.
When enrolled Qualified Providers have staff turnover and require training of new staff, county office staff are responsible for meeting these training needs. Set up informal sessions as quickly as possible to allow the Qualified Provider continuity in participating in the TEMP program.
State Office retains records of which individuals have met training requirements for the TEMP program. Notify State Office of the request and the name of anyone trained.