1855.030.00 Healthcare Coverage – DSS Manuals

IM-18 February 6, 2018 ; IM-142 November 22, 2017 ; IM-110 December 31, 2015

Coverage for an unborn child enrolled in the Show-Me Healthy Babies Program includes all prenatal care and pregnancy related services for the mother which benefit the health of the unborn child, and promote healthy labor, delivery, and birth. SMHB cases will be identified on MXIX with the following Medical Eligibility (ME) Codes:

ME 95 – Prenatal, Labor, and Delivery for an unborn child, whose mother is a citizen or eligible alien and was denied on MPW for excessive income (Must have income above 196% of FPL and less than or equal to 300% of FPL. This coverage will show on MXIX as Type of Coverage (TOC) “C” and Level of Care (LOC) 95; ME 96 – Prenatal, Labor, and Delivery for an unborn child, whose mother was denied on MPW for citizenship or eligible alien status, and has income of 0% of FPL up to and including 300% of FPL. This coverage will show on MXIX as Type of Coverage (TOC) “C” and Level of Care (LOC) 96; ME 98 – Post-partum coverage for women previously approved for ME 95. This coverage will show on MXIX as Type of Coverage (TOC) “C” and Level of Care (LOC) 98;

NOTE : Women approved previous to post-partum period under ME 96 receive one post-partum visit.

There is no waiting period before an unborn child may be enrolled in the Show-Me Healthy Babies Program. If eligible, coverage begins with the date of application.

EXAMPLE: Mary is pregnant and applied for MO HealthNet for Pregnant Women (MPW) on 11/5/20xx. Mary is a US Citizen and her income is over the income guideline for MPW. She is denied for MPW and screened for SMHB. Her income is at or below 300% of FPL and she is eligible for SMHB. Her begin date for coverage is the day she applied: 11/5/20xx.