Eligibility Online Manual

M1202C Pregnant By Choice


Purpose: This section will assist in determining eligibility for Pregnant By Choice.


Current Policy Effective Date: January 1, 2014

Date Last Reviewed: September 4, 2014

Previous Policy: November 1, 2012

POL M1202C: DETERMINING ELIGIBILITY FOR PREGNANT BY CHOICE

1. Applicants Must Be Transitioning From The Pregnant Women Program

Eligibility is determined in the 60 day postpartum period.

2. Applicants Must Not Be Eligible For Another Medicaid Program

3. Applicants Must Elect To Participate

Applicants are required to complete the Pregnant By Choice Questionnaire form in addition to the renewal form or Health Coverage Application.

4. Applicants Must Not Have Health Insurance

5. Applicants Must Not Have Undergone A Procedure To Permanently Prevent Pregnancy

6. Applicant Must Not Be Pregnant

7. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

8. Applicants Must Meet Age Requirements

Applicants must be age 19 through age 44.

9. Applicants Must Meet Income Requirements

Countable income must be equal to or less than 159% of the FPL. Refer to Medicaid Table 1. Refer to Section M901 to determine if income is countable.

10. Applicants Do Not Have Resource Test

11. Applicants May Not Receive Retroactive Benefits

12. Applicants May Have Eligibility For 12 Continuous Months

Eligibility continues for 12 months from the effective date of eligibility or for 12 months from the last periodic review.

13. Benefits Begin First Month Following End Of 60 Day Postpartum Period

14. Clients Must Be Reviewed

Clients must be reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

15. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

    • Client does not complete review.

    • Client turns age 45.

    • Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.

    • Client moves out of state.

    • Client dies

    • Client determined no longer eligible.

    • Client’s 12-month period ends and is no longer eligible.

Reference:

Defining Group: Section 1115(a) of the Social Security Act

Clarifying Information:

1. Pregnant By Choice extends family planning options to women who would typically lose their Medicaid benefits after the 60 day postpartum period.

Worker Responsibilities:

Closing Cases

Send a 15-Day closure notice when an adverse action has occurred.