MedicaidAdministrativeMedium impact
What is MO HealthNet Presumptive Eligibility?...and how to make it work in my pharmacy
Missouri Medicaid (MO HealthNet)·MO·Pharmacy
Effective date
Mar 27, 2023
We identified it
Jun 20, 2026
Summary
MO HealthNet has updated guidance for processing Presumptive Eligibility (PE) pharmacy claims, allowing temporary coverage for eligible individuals while their full applications are processed. Pharmacies must recognize PE-3 and PE-3 TEMP forms, dispense 30-day supplies, keep documentation, and establish reprocessing workflows for when patient DCN numbers become active.
Action Required
Immediately: Train pharmacy staff to recognize PE-3 and PE-3 TEMP forms for MO HealthNet Presumptive Eligibility patients. Establish workflow to: 1) Copy and file PE forms for documentation, 2) Dispense only 30-day supplies using preferred drug list, 3) Process claims as 'cash' and place on patient account for reprocessing, 4) Set reminders to reprocess claims 5-30 days later when DCN becomes active, 5) Keep MO HealthNet Pharmacy Administration contact (573) 751-6963 readily available for claim issues.