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Title 8: Medicaid Page 8 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…

Ms. T is granted eligibility effective June 1 because (1) she would have been eligible in June as a pregnant woman had she applied; (2) she has bills for covered Medicaid services in June; and (3) increased income is the only reason that she is currently ineligible. Ms. T is placed in the MAC coverage group beginning with the month of June. Eligibility continues throughout the pregnancy. If Ms. T is eligible and enrolled in Medicaid on the last day of her pregnancy, she will be eligible for the 12- month postpartum period beginning the month following the last day of her pregnancy. Ms. T is also potentially eligible for Medically Needy for the month of May if she had Medicaid-covered bills and if her excess income is the only reason that she is ineligible for another Medicaid coverage group during the month. 3. Ms. Z’s baby was born July 23. Ms. Z applies for Medicaid July 30 and requests retroactive eligibility for April, May, and June. She is over income for July. Ms. Z is eligible for the retroactive months. Ms. Z is continuously eligible because she was both eligible and enrolled in Medicaid while pregnant. 4. Ms. G is a pregnant undocumented alien who applied for Medicaid in October. She verified an emergency medical condition with dates of service in October only and met all other eligibility requirements in that month, so she was approved for limited Medicaid for emergency services coverage for the month of October. Ms. G is continuously eligible through her pregnancy and postpartum period. A claim is submitted for Ms. G for December for non- emergency services. The claim is denied as Ms. G is only continuously eligible for limited emergency services. On January 10, Ms. G submits a Verification for Emergency Health Care Services (VEHCS) Form 470-4299 for services received on January 2nd and 3rd. She also reports an increase in income. Her income exceeds program limits for January, but she meets all other eligibility requirements that month. Since she was previously eligible and enrolled in Medicaid while pregnant and Ms. G is continuously eligible, and has provided a new VEHCS, Ms. G’s emergency services rendered on January 2nd and 3rd are covered. Postpartum Eligibility Legal reference: 441 IAC 75 (Rules in Process) Medicaid continues to be available during the 12-month postpartum period to a woman who was eligible and enrolled in Medicaid on the date her pregnancy ends.