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Louisiana Medicaid Eligibility Manual Eligibility Determinations

Issued October 11, 2022

Page 1 of H-2900 Replacing May 09, 2022 Revised/added text indicated by underscore

Deleted text indicated by “**” H-2900 PREGNANT WOMEN GROUP

H-2901 GENERAL INFORMATION

In accordance with the requirements of the Patient Protection and Affordable Care Act of 2010, referred to as the Affordable Care Act (ACA), pregnant applicants/beneficiaries shall be screened and eligibility in the Pregnant Women (PW) group determined using the Modified Adjusted Gross Income (MAGI) methodology.

Eligibility in this group for individuals whose MAGI-based income is at or below 138 percent of the Federal Poverty Level (133 percent of the FPL, plus a 5 percent disregard) may begin: • At any time during a pregnancy; and • As early as three (3) months prior to the month of application. Eligibility cannot begin before the first month of pregnancy.

Note: The PW group certification may extend through the calendar month in which the 12-month postpartum period of continuous eligibility ends.

An applicant/beneficiary whose pregnancy terminated in the month of application or in one of the three (3) months prior, without a surviving child, shall be considered a pregnant woman for the purposes of determining eligibility in the PW group.

Certification shall be from the earliest possible month of eligibility (up to three (3) months prior to application) through the month in which the 12 months of continous eligibility for extended postpartum ends. Retroactive eligibility shall be explored regardless of current eligibility status.

If the applicant/beneficiary is eligible for any of the three (3) prior months, she remains eligible throughout the pregnancy and until the 12 months of continous eligibility for extended postpartum ends. When determining retroactive eligibility, actual income received in the month of determination shall be used.

Example: Mary Smith applies in June, which is her fifth month of pregnancy. Her income in June exceeds the allowable income, however, in