Eligibility Online Manual
M1202A Pregnant Women
Purpose: This section will assist in determining eligibility for Pregnant Women.
Current Policy Effective Date: July 1, 2023
Date Last Reviewed: June 28, 2023
Previous Policy: July 1, 2018
POL M1202A: DETERMINING ELIGIBILITY FOR PREGNANT WOMEN
1. Applicants Must Meet Basic Eligibility Factors
Refer to Section M600 for a description of all basic eligibility factors.
Applicants must be a U.S. Citizen or a lawful present immigrant.
Applicants residing in the U.S. under the Deferred Action Childhood Arrival (DACA) act are not eligible for this program.
2. Applicants Must Meet Income Requirements
3. Applicants Do Not Have Resource Test
4. Benefits Begin The First Day Of The Application Month If Determined Eligible
Benefits begin on the first day of the application month, if eligible, and will continue through the 12 month postpartum period.
5. Applicants May Be Eligible For Retroactive Benefits
Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.
Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.
Retroactive benefits will not be authorized prior to the month pregnancy begins.
6. Non-Citizen Applicants Receive Limited Emergency Services
Pregnant women who are not a U.S. Citizen or a lawful present immigrant may receive emergency services, including labor and delivery. Refer to Emergency SVC Family & Children's Section M1205 for more information.
7. Clients Must Be Reviewed
Clients must be reviewed at the end of their 12 month postpartum period to determine continued eligibility under another Medicaid program to include Pregnant By Choice.
Send the Pregnant by Choice Questionnaire in the month of the estimated due date or upon notification of the baby’s date of birth.
Have You Had Your Baby notice is sent 30 days after the due date when the birth of the child has not been reported.
Refer to Section M1403 for additional information on reviewing eligibility
8. Clients May Need To Cooperate With Child Support
Unmarried women who give birth while on Medicaid will be required to cooperate with child support enforcement per birthing cost requirements in the statues listed below.
9. Clients May Lose Benefits
Pregnant Women benefits will close on the first day of the next month when any of the following occur (Refer to Section M1404 for additional information on closing cases):
Client has moved out of state.
Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.
Client is determined no longer eligible.
Client has not provided information on the date of birth of the newborn within the 12 month postpartum period.
Defining Group: 42 CFR 435.116
42 CFR 435.170
Child Support: 42 CFR 435.610
W.S. 14-2-1008 & 42-4-122
Income: Social Security Act § 1902(10)(A)(i)(IV)
Resource Transfer Provisions Do Not Apply.
The 12 month postpartum period begins in the month following the baby’s date of birth or estimated due date. For example, if the baby is born on September 15th, 2023, the postpartum period will end September 30th, 2024.
A mother on any full Medicaid or Kid Care CHIP Program, who reports that they had a baby while on Medicaid, even if they did not report their pregnancy, is still entitled to 12 months postpartum coverage beginning with the month following the birth of the baby.
The only programs this does not include is: Subsidized Adoption, 12 Month Extended, Emergency Services, Pregnant By Choice (PBC), QMB, SLMB, QI, Basic Foster Care, and Institutional Foster Care.
Determining Countable Income
1. Refer to Section M901 for information on calculating income.
Determining Retroactive Benefits
1. Determine whether each approved or denied applicant incurred medical bills during any of the three months prior to the month of application.
Closing Cases After The 12 Month Postpartum Period
1. Close the case after the 60 day postpartum period when the date of birth cannot be determined and one of the following occurs:
1A. Client has not completed and returned a review form. Refer to Section M1404 for more information on closing cases.
1B. Client has not provided the baby’s date of birth. Refer to Section M1404 for more information on closing cases.
2. If the mother has received all benefits and is not eligible under another coverage group.
3. Send 15-Day closure notice.