This policy became obsolete with the implementation of the Affordable Care Act (ACA) January 1, 2014. It was replaced with section 1900.000.00 PRESUMPTIVE ELIGIBILITY (PE) PROGRAMS in the Income Maintenance Manual.



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.


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.


  1. Definition

    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.

  2. Qualified Provider Responsibilities

    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:

    1. Have the pregnant woman complete the appropriate portion of the QP-1 “Temporary Medicaid during Pregnancy (TEMP) Eligibility Determination”, providing information on income and household size.
    2. Based on the woman's statement, make an eligibility determination for temporary Medicaid coverage.
    3. If the woman is eligible for TEMP:
      1. Provide her with a temporary Medicaid identification card (QP-2) covering the date of the determination through the last day of the month following date of determination.  Explain the use of and the limited coverage provided by the temporary Medicaid card.
      2. Tell the woman of her responsibility to make a formal application for MC+ with her local Family Support Division office by the end date on her temporary Medicaid identification card (QP-2).  Explain that if the woman files an application by this date, her temporary healthcare coverage could be extended to the date of final determination of her MC+ application.
      3. Send notice of the TEMP eligibility determination to the FSD office in the county where the woman resides the same or next day so that FSD receives it within 5 working days of the determination.
    4. If the woman is not eligible for TEMP:
      1. Provide her with a copy of the determination (QP-1) including the reason she is not eligible for temporary Medicaid.
      2. Advise the pregnant woman of her right to apply for MC+ with her FSD office for a formal determination of MC+ eligibility.
      3. Send notice that the woman is not eligible for TEMP to the woman's county FSD office the same or next day so it is received by FSD within 5 working days of the determination.
  3. The Qualified Provider is also responsible to:
    1. Designate a member of the provider's staff to be a liaison with the FSD office.
    2. Maintain adequate records on all TEMP eligibility determinations.


It is the responsibility of the FSD county office to:

  1. Designate a member of the staff to be a liaison with the Qualified Provider(s) in the county.  This liaison provides technical assistance to the QP who experiences problems with eligibility determinations and serves as a contact for the QP on specific cases.
  2. Review QP-1 forms and TEMP cards (QO-2) received in the county office.  If necessary  information is missing from the form, call the QP liaison to obtain it.
    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.
  3. For TEMP eligibles, enter the information from TEMP eligibility determinations into the system via the ITMP transaction within one (1) working day of receipt.  See ITMP instructions under the heading “B. ITMP System”.
  4. For Temp eligibles, set up a case record with the TEMP information.  Label the record with the type of assistance P, the DCN, and the temporary number.  Maintain the county office copy of the QP-1 in this file with a cover sheet labeled “TEMP Section”.  File copies of any QP-2 cards of IM-29(TEMP) letters issued in this section, also.
    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:

    1. Screening on IPAR prior to the application interview may indicate TEMP eligibility.  Provide this information to the worker prior to the interview.
    2. TEMP eligible women are identified if they present a current TEMP identification card (QP-2).
  5. When the TEMP eligible woman applies for MC+ in the same month as the TEMP determination (or before), take no action regarding TEMP eligibility.  A TEMP Authorization Letter (IM-29TEMP) is unnecessary, because the woman has a QP-2 good through the end of the following month.  The system tracks the MC+ application in relation to the TEMP eligibility period.
  6. When the TEMP eligible woman applies for MC+ in the last month of TEMP eligibility, give her an IM-29(TEMP) to extend TEMP coverage to 15 days from the date of application.  For example, a TEMP eligible woman, whose TEMP eligibility expires August 31, applies for MC+ on August 20.  Give her an IM-29(TEMP) with coverage from September 1 through September 4, 1991.  (September 4 is the 15th day of her MC+ application.)
    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.

  7. If there is no action taken on the MC+ application by the last day of TEMP eligibility, there is an automatic extension of TEMP coverage.

    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.

  8. For TEMP denials, do not enter in ITMP and do not set up case records.  Counties are required to report statistical information on these cases to State Office.  Keep all denial QP-1 forms in one file and prepare to submit information regarding these cases to State Office upon request.

0945.020.00 TEMP FORMS

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.

0945.025.00 ITMP SYSTEM

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.

  1. Screen for prior assistance history.  Use the SCLR process to determine if the TEMP claimant is known to DSS.  If the individual is known, record the DCN on the QP-1.  If the screening indicates a pending MC+ application, inform the caseworker of the receipt of the TEMP determination so the worker can determine whether to issue an IM-29(TEMP).  Go to step 3.  If the individual is not known to the system, go to step 2.
  2. Assign a DCN.  If the individual has no previous record of participation, assign a DCN now.  A DCN is necessary to enter information into the ITMP screen.  Use the identifying information from the QP-1 to make the assignment.

    NOTE:  Do not enter the Social Security Number as it has not been verified.  Record the DCN on the QP-1.

  3. Enter information from the QP-1 and QP-2 card into the ITMP screen.  Even if the screening in number 1 shows an active MC+ case, an ITMP transaction is required.  The Qualified Provider has issued a temporary number which must be cross-referenced to the DCN to assure Medicaid/MC+ claims payment.
  4. Use IPAR for inquiry regarding TEMP eligibility.  The ITMP screen is for entry only.  Do not use it for inquiry.  The IPAR screen allows inquiry regarding TEMP eligibility.  TEMP eligibility is indicated by type of assistance P under the IM participation.  Eligibility information can be accessed by selecting the P type of assistance from that screen.
  5. “Disconnect” temporary numbers from DCNs by using the delete function of ITMP.  If, after entering an ITMP transaction, you find you have entered a temporary number incorrectly, you can delete this information from the system and re-enter the ITMP transaction using the correct number.  This is an important function since ITMP allows only one DCN to be connected to any temporary number.


The information in the ITMP system is used by the IM system to do several tasks:

  1. The system calculates the ending date of the TEMP eligibility period based on the beginning eligibility date issued by the Qualified Provider.  The system assigns a level of care “F”.
  2. The system changes the level of care on TEMP cases from “F” to “S” when a MC+ application is rejected prior to the ending date of the presumptive eligibility coverage (if no other MC+ application is still pending).  These levels of care indicate whether payment for services is from federally matched or state only funds.
  3. If the TEMP recipient applies for MC+ in the month after the TEMP determination, the system updates ITMP to extend TEMP eligibility 15 days past the MC+ application date.

    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.

  4. If the TEMP recipient applies for MC+ in the month of the TEMP determination, or the month prior to the TEMP determination, the system checks to see if any action has been taken on the MC+ application by the last working day of the second month of TEMP eligibility.  If no action has been taken, the system extends TEMP eligibility another seven days.  This procedure repeats until the application has been 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).

0945.035.00 HEARING RIGHTS

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.