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Title 8: Medicaid Page 7 Iowa Department of Health and Human Services Employees’ Manual Chapter F: Coverage Groups Pregnant or Postpartum Women and... Revised October 10, 2025 Continuous Eligibility for Pregnant and… A pregnant woman eligible and enrolled in Medicaid who meets all eligibility criteria (including income) for any month of the retroactive period is continuously eligible for Medicaid beginning with the first month of the retroactive period in which eligibility is established. The woman must meet the following retroactive Medicaid eligibility requirements:  The woman would have been eligible in the retroactive period had she applied.  The woman has medical claims she has incurred for services that are payable under the Medicaid program for the retroactive month in which she would have been eligible had she applied. The bill can be paid or unpaid.  The woman was pregnant in that retroactive month. A pregnant woman who is determined eligible and is enrolled for a retroactive month while she is still pregnant continues to be eligible This policy does not apply to women who would have been eligible or potentially eligible only under Medically Needy with a spenddown that has not been met or state-only in the retroactive period. NOTE: While a pregnant woman remains continuously eligible during her pregnancy, with limited exceptions, it is possible for a pregnant woman to change coverage groups during her pregnancy unless she is eligible as a Hawki member or chose to remain on IHAWP during her pregnancy and postpartum period.

1. Mrs. K, aged 25 and pregnant, receives Medicaid under FMAP. On August 15, she reports that her husband started receiving Social Security disability in the amount of $1,200 per month. The worker determines that the household’s income now exceeds FMAP limits for a four-member household (Mr. K, Mrs. K, their three-year-old son, and one unborn child). Mrs. K is continuously eligible. She would move to transitional Medicaid and may remain eligible through her 12-month postpartum period. 2. Ms. T, age 37, is six months pregnant when she applies for Medicaid on August 5. The worker determines that Ms. T’s countable income exceeds Medicaid limits for a two-member household under any program except Medically Needy with a spenddown. Ms. T also requests Medicaid benefits for the retroactive months of May, June, and July. She has bills for Medicaid-covered services for June. The worker determines that Ms. T was eligible under the MAC coverage group for the month of June.