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BEM 657 2 of 3 MATERNITY OUTPATIENT MEDICAL SERVICES (MOMS) BPB 2016-011 7-1-2016

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

MSA Rsponsibilities Medical Services Administration (MSA) is responsible for verifying eligibility and establishing the coverage period. NONFINANCIAL FACTORS

Residence The individual must be a Michigan resident. Social Security Number A Social Security number (SSN) is not required for this program. Pregnancy Verification of pregnancy is not required. FINANCIAL ELIGIBILITY FACTORS

Assets There is no asset test. Fiscal Group Income The group is the same as MAGI related groups. Fiscal group income must be at or below 195 % of the poverty level. Verification of income is not necessary unless the individual’s statement is inadequate or questionable. COVERED SERVICES Coverage for pregnant Medicaid ESO beneficiaries is limited to the following outpatient pregnancy and postpartum-related services:  Prenatal care and pregnancy-related care.  Pharmaceuticals and prescription vitamins.

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Page 2

Official source

BEM 657 2 of 3 MATERNITY OUTPATIENT MEDICAL SERVICES (MOMS) BPB 2016-011 7-1-2016

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

MSA Rsponsibilities Medical Services Administration (MSA) is responsible for verifying eligibility and establishing the coverage period. NONFINANCIAL FACTORS

Residence The individual must be a Michigan resident. Social Security Number A Social Security number (SSN) is not required for this program. Pregnancy Verification of pregnancy is not required. FINANCIAL ELIGIBILITY FACTORS

Assets There is no asset test. Fiscal Group Income The group is the same as MAGI related groups. Fiscal group income must be at or below 195 % of the poverty level. Verification of income is not necessary unless the individual’s statement is inadequate or questionable. COVERED SERVICES Coverage for pregnant Medicaid ESO beneficiaries is limited to the following outpatient pregnancy and postpartum-related services:  Prenatal care and pregnancy-related care.  Pharmaceuticals and prescription vitamins.