Page 3

Medicaid Eligibility Manual Eligibility Determinations

Issued March 01, 2024 Page 3 of H-1900 Replacing February 27, 2024 Revised/added text indicated by underscore Deleted text indicated by “**”

• The individual is no longer a resident of the state

● It is determined that eligibility was erroneously granted at the most recent determination of eligibility because of agency error or fraud, abuse, or perjury attributed to the individual

• The individual dies

**

Populations eligible for extended postpartum on April 1, 2022:

• Current beneficiaries who are pregnant as of April 1, 2022 or who enroll based on pregnancy or become pregnant after April 1, 2022.

• Current beneficiaries who enrolled in Medicaid or CHIP while pregnant and who are no longer pregnant but who are still within a 12-month postpartum period as of April 1, 2022.

• Individuals who were pregnant during a period of retroactive eligibility on or after April 1, 2022.

Example: Ava was pregnant and her pregnancy ended on May 15, 2022. Ava submits a Medicaid application and is determined eligible on June 15, 2022. Since Ava would have been eligible had she applied during her retroactive period she will receive continuous coverage through the end of the month in which her 12-month postpartum period ends, which is May 31, 2023.

Spend-Down Medically Needy

An individual who attained Medicaid eligibility through a Spenddown while pregnant is eligible for the extended postpartum coverage even if the individual does not have sufficient incurred medical or remedial care expenses to meet their spenddown in any subsequent budget period during the pregnancy or extended postpartum period.

Pregnant Non-Citizens Eligible for Emergency Services Only

Pregnant Qualified non-citizens and non-qualified non-citizens are eligible for extended postpartum coverage. Services during the