Policy Requirements
Applicants for P4HB must meet the following eligibility requirements:
Age – women ages 18 (month of 18th birthday) through 44 (month of 45th birthday)
Must be able to become pregnant
Georgia resident
Citizenship/Immigration Status/Identity Reasonable opportunity policy applies (refer to Section 2215) The signed Streamline application meets the declaration of citizenship requirement, so a separate declaration is not required.
Third-Party Liability (TPL), DMA285 is not required if there is no TPL.
Income up to and including 211 percent of the FPL based on MAGI Rules. Individuals that meet on tax filer criteria are potentially eligible to receive coverage based on the MAGI Medical Assistance policy. Refer to Section 2245, Filer Status/Specified Relative Relationship and Section 2610 - Magi Budget Groups/Assistance Units
Limited to 24 months for (180-IPC and 181 and 182-RM services) for each reported VLBW baby and will be disenrolled after 2 years of participation.
No retroactive (three months prior) coverage
No Emergency Medical Assistance (EMA) coverage
Must report changes within 10 days
A woman enrolled in P4HB who becomes pregnant can apply for Presumptive Eligibility (PE) Pregnant Women Medical Assistance. Her P4HB services will be terminated the same day of her pregnancy eligibility.
Post-partum women who were on Medicaid coverage and enrolled in a Georgia Families Care Management Organization (CMO) at delivery will be automatically cascaded to the appropriate aid category and enrolled in the plan with which they were affiliated. These women will be afforded the opportunity to choose a new CMO if desired.
If a member has an active P4HB case 180 or 181 but does not apply for PE Pregnant Women Medical Assistance until after she delivers her baby. There must be a “Continuing Medicaid Determination” (CMD) for the member to cascade from P4HB to Pregnant Women Medicaid. Refer to 2052 Continuing Medicaid Determination .
All P4HB services, FP-181, IPC-180, and RM-182 & 183 are subject to annual renewals.
All women between the ages of 18 through 44 must receive notification their application for P4HB has been approved, denied or their P4HB eligibility has been terminated.
All pregnant women receiving Medical Assistance under any class of assistance (COA) will be sent a letter in their eighth month of pregnancy from their CMO informing them of the P4HB program. Pregnant women whose Medical Assistance cases are closing and who are not eligible for another COA may be eligible for P4HB Family Planning services.