101.18.03 WOMEN IN HEALTHIER MS WAIVER OR MEDICARE COST-

SHARING GROUPS TRANSITIONING TO COE-088 FOR PREGNANCY AND POST-PARTUM ELIGIBILITY The Healthier MS Waiver (HMW) and Medicare Cost Sharing eligibility groups do not cover pregnancy-related services. If a woman is active in the HMW or as a QMB, SLMB or QI and reports that she is pregnant and needs pregnancy-related coverage, take the following action: • Obtain her expected due date, • Using information from her ABD application or last review form, use non- filer MAGI household composition and budgeting rules to determine her eligibility for COE-088, • If eligible, transition her to COE-088 for the duration of the pregnancy and post-partum period. MEDS will set a review date for the end of her post partum period. Evaluate eligibility for all COEs (ABD and MAGI) when completing her review after the 12 month post partum period. • If ineligible for COE-088 using non-filer rules, contact the ABD recipient to confirm whether the use of non-filer rules is appropriate. If the recipient is a tax filer or dependent of a tax filer, apply filer rules as appropriate to determine eligibility for COE-088. o If eligible using filer rules, transition ABD recipient to COE-088 for the duration of the pregnancy and post-partum period. At the end of her post-partum period, the system will automatically transfer her back to her original ABD COE. If her annual review is due or overdue, give priority to completing the needed redetermination of ABD eligibility. o If ineligible using filer rules or if filer rules do not apply and the ABD recipient is ineligible using non-filer rules, issue a manual DOM-305, Notice of Action, advising the ABD recipient that she is not eligible for Medicaid as a pregnant woman but that she remains eligible in her original ABD coverage group.