Presumptive Eligibility (PE) is short-term (60 days or less) Medicaid coverage for children up to age 19 or for pregnant women. Presumptive Eligibility is effective from the date of the eligibility determination until the last day of the following month. This means covered medical services accessed during this time by the eligible individual will be paid by Medicaid.
To become a PE/MOSAA Determiner, you must first be a member of an eligible agency or organization. You will be required to go through a PE training session in order to become certified.
Medicaid On-Site Application Assistance (MOSAA) refers to the process of completing an application for regular (as opposed to short-term) Medicaid for children or for women who are pregnant or are seeking family planning services. Effective July 1, 2011 men who met the specified criteria are also eligible for family planning services.
MOSAA does not result in ‘instant eligibility’ in the same way Presumptive Eligibility does. MOSAA allows a PE/MOSAA Determiner to give Medicaid applications to clients, gather the information required to determine eligibility (such as proof of income, proof of insurance, etc.), and conduct an eligibility interview. The resulting paperwork is mailed to the local Income Support Division office where a final determination of eligibility is made.
A finalized and approved MOSAA application may result in 12 months of Medicaid eligibility for children; coverage for pregnant women (which includes two months of post-partum care); and one year of family planning Medicaid coverage for women and men.
To become a PE/MOSAA Determiner, you must first be a member of an eligible agency or organization. You will be required to go through a training session in order to become certified. This training is now available on-line as well as in person.
For more information regarding trainings or the PE/MOSAA process, please e-mail us at HSD.PEDeterminer@hsd.nm.gov.
