Page 5

TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 5 26 DE Reg. 323 (10/01/22) 15200.2 Pregnant Woman Group General Eligibility Requirements A pregnant woman must meet the general eligibility requirements described in Section 14000. Exception: A pregnant woman is not required to cooperate in establishing paternity and obtaining medical support. 15200.3 Technical Eligibility A woman may apply for Medicaid and be found eligible under the Pregnant Woman Group in the month the pregnancy ends or in a month prior to the month the pregnancy ends (while still pregnant), including during a period of retroactive eligibility. Self-attestation of pregnancy and the unborn fetus count is accepted unless the information provided is not reasonably compatible with other available information. Other available information may include medical claims that are not reasonably compatible with such attestation. 26 DE Reg. 952 (05/01/23) 28 DE Reg. 387 (11/01/24) 15200.4 Financial Eligibility Financial eligibility is determined using the modified adjusted gross income (MAGI) methodologies described in Section 16000. The pregnant woman counts as at least two family members for the financial eligibility determination. If a pregnant woman is diagnosed with a multiple pregnancy, the unborn fetus count is increased accordingly. Household income must not exceed 212% of the Federal Poverty Level (FPL). 17 DE Reg. 845 (02/01/14) 15200.5 Continuous Eligibility Once a pregnant woman is determined eligible, she remains eligible throughout the pregnancy and the postpartum period regardless of changes in household income. 15200.6 Postpartum Period Statutory Authority 42 CFR 435.116 42 CFR 435.170 The 12-month postpartum period is a mandatory extension of coverage for women who were determined eligible in the month the pregnancy ends, in a month prior to the month the pregnancy ends (while still pregnant), or who received services while pregnant during a period of retroactive eligibility. A woman cannot apply and be found eligible for the postpartum period alone. Coverage begins on the day the pregnancy ends and continues through the last day of the month in which the 12 months ends. Undocumented aliens are not eligible for the postpartum period. 26 DE Reg. 323 (10/01/22) 26 DE Reg. 952 (05/01/23) 28 DE Reg. 387 (11/01/24) 15210 Deemed Newborn Group The section describes the eligibility requirements for the Deemed Newborn Group. An infant born to a woman eligible for and receiving Delaware Medicaid (including emergency services and labor and delivery only coverage) on the date of the infant’s birth is deemed eligible at birth. 15210.1 Deemed Newborn Group General Eligibility Requirements An infant must meet the general eligibility requirements described in Section 14000. Exceptions: An application for the newborn is not required. A newborn deemed eligible does not have to provide or apply for a Social Security number until age one. 15210.2 Financial Eligibility There is no income test. Eligibility begins on the date of birth and continues until the end of the month in which the