Procedures

Follow the steps below to determine Medicaid eligibility for Pregnant Woman Medicaid:

Step 1 Review the application and contact the applicant if additional information is needed that is not included in the application. Step 2 Determine the AU and BG. Refer to Chapter 2600, Family Medicaid Assistance Units and Budget Groups. If an applicant applies for Pregnant Woman Medicaid after her pregnancy has terminated, accept her statement of pregnancy, fetus number, and termination date of pregnancy. Step 3 Obtain the number of fetuses and estimated date of delivery (EDD) from a medical provider or from the applicant. Written verification of the pregnancy is not required. Step 4 Establish all points of basic eligibility. Verify applicant’s citizenship/qualified immigrant status and identity. Accept the applicant’s statement for all other points of basic eligibility unless the statement conflicts with information known to the agency or is deemed questionable. Refer to 2215 Citizenship / Immigration / Identity . Document in the case record the conflict of information or reason questioned and the verification that is subsequently requested. Citizenship/Immigration Status/Identity are not a requirement for Emergency Medical Assistance (EMA). Refer to 2054 Emergency Medical Assistance . Step 5 Based on tax filer or non-tax filer status, apply the appropriate FPL depending on the BG size, to determine eligibility for the Pregnant Women. Refer to 2245 Living With A Specified Relative / Tax Filer / Non-Filer Status . Refer to Appendix A2 , Financial Limits for Family Medicaid. Step 6 Verify Modified Adjusted Gross Income (MAGI) income using available electronic data sources. Refer to 2051 Verification . Step 7 Complete the budgeting process. Refer to 2669 MAGI Budgeting . Step 8 If eligible, approve Pregnant Women Medicaid. If ineligible, allow case to cascade to Pregnancy Spend Down Medicaid (or PCK, depending on age of Pregnant Woman and amount of income), complete and document the results of a Continued Medicaid Determination (CMD). Refer to 2052 Continuing Medicaid Determination . When the MAGI income limit is above the PeachCare for Kids® income limit, or the applicant is 19 years of age or older, a system CMD will be completed to the Federally Facilitated Marketplace (FFM). Step 9 If the application originated as a Presumptive Medicaid, screen in GAMMIS to determine if applicant is actively receiving as a Presumptive Medicaid pregnant woman (aid category 865). If so, link GA Gateway client ID numbers to GAMMIS member ID numbers. This must be done the same day the application is approved. Step 10 Refer pregnant women to WIC and document the case. Refer to 2985 Women, Infant and Children (WIC) Services . Step 11 Initiate contact with the member in the month prior to the month in which the EDD falls. Continue these monthly contacts to establish that the pregnancy continues. If the pregnancy terminates with a live birth, the child meets the Deemed Newborn requirement and Medicaid must be established for the newborn. Refer to 2174 Newborn Medicaid . Continue Pregnant Women Medicaid eligibility 12 months following termination of pregnancy. Terminate eligibility at the end of the month in which the 12 th month falls. Begin a CMD for the pregnant woman in the month prior to the last month of Pregnant Women Medicaid eligibility.