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Chapter: 2000 Coverage Groups Program: MSSI, SFP 9 2. are Medically Needy, 3. are presumptively eligible.

A pregnant woman who is eligible for regular Medicaid for at least one month, including a retroactive month, is eligible to receive Medicaid through her pregnancy and until the end of the 12th month after the birth (postpartum period), regardless of any changes except for Presumptive Eligibility for Pregnant Women and Emergency Medical Assistance for Noncitizens. 2030.0702 Pregnancy Verification (MFAM) Self attestation of pregnancy, the anticipated due date, and the number of unborns is acceptable. 2030.0704 Presumptively Eligible Pregnant Women (MFAM) Presumptive eligibility is a determination of eligibility made by a designated provider based on the applicant’s verbal statements about the SFU's income. The income must be equal to or below the income limit. Citizenship status is not a factor of eligibility for this coverage group.

This is temporary coverage that begins with the date the presumptive eligibility determination is completed by the Qualified Designated Provider (QDP) and ends on the date of the Medicaid determination if an application for full Medicaid is filed by the last day of the month after the presumptive eligibility determination. If an application for full Medicaid is not filed by then, presumptive eligibility ends on the last day of the month after the presumptive eligibility determination. Only one presumptive period per pregnancy is allowed and these benefits cover only ambulatory prenatal services. It does not cover inpatient hospital services or delivery. For the pregnant woman to get coverage beyond the presumptive period, a full Medicaid application is necessary and the QDP is expected to assist with this application process. 2030.0800 RETROACTIVE MEDICAID (MFAM) The following passages covers the Retroactive Medicaid requirements and the date of entitlement for Retroactive Medicaid. 2030.0812.01 Retroactive Medicaid (MFAM) Medicaid maybe authorized for up to three months prior to the date of application for children under age 21 and pregnant women, including their postpartum period. 2030.0812.02 Requirements for Retroactive Coverage (MFAM) The following requirements must be met in order to be eligible for retroactive Medicaid coverage, for children under age 21 and pregnant women, including their postpartum period:

1. A request for retroactive Medicaid can be made by the individual or for a deceased individual by a designated representative or caretaker relative, by filing a medical assistance application. 2. In the retroactive period, the individual must have received medical services which would be reimbursable by Medicaid. The individual's statement that there were unpaid medical bills for any of the three months will be accepted. The individual is not required to verify that the bills exist or the services will be covered by Medicaid. 3. The eligibility specialist will determine eligibility for each of the retroactive month(s) using eligibility criteria for any Medicaid coverage group, regardless of the type of coverage for which the individual applied. 4. A determination of eligibility must be made for each of the month(s) in the period. 5. Once current income has been verified and any discrepancies resolved, staff must accept self-attestation that the individual’s income was consistent during the retroactive period. Request additional information only if the income is inconsistent or information known to