101.19.01 TRANSITIONING THE PREGNANT CHIP CHILD TO MEDICAID COE-088

For most children, program changes are effective only at review because of the continuous eligibility provision for children. However, when the agency becomes aware that a CHIP child is possibly pregnant, a special review must be completed to verify pregnancy/due date. There is no need to determine if the minor is eligible for Medicaid coverage as a pregnant woman, because pregnant minors have income exemptions that assure eligibility. If pregnant, enter the due date in the system, process eligibility and the child will transition from CHIP to COE-088 Medicaid for the duration of the pregnancy and post-partum period. However, if the office learns of the change too late, i.e., the minor is at the end of her pregnancy or has already delivered, no action is taken to change the program. The program transition from CHIP to Medicaid is an adverse action. If action is taken by the 15th of the current month, CHIP will terminate at the end of the current month and the pregnant minor will move to Medicaid COE-088 the following month. If action is taken after the 15th, CHIP will continue for another month before transitioning to Medicaid. The head of household is issued a notice which contains the following information about the child’s eligibility: • Date the pregnant child will be removed from CHIP; • Date the child will be eligible for Medicaid as a pregnant woman. • The verified delivery date and the requirement to report an earlier or later date. • Date the child will become ineligible for Medicaid as a pregnant woman. • The child’s review due date. • Information about coverage for a 12-month post-partum period. • The deemed eligible provision for children born to Medicaid-eligible women. When the pregnant minor’s review comes due at the end of her postpartum period while she is on COE-088, the review will be completed. If the child is eligible for full Medicaid or CHIP, action can be taken to change the child from COE-088 to the appropriate MAGI or CHIP coverage group for a child under age 19 effective with the month following postpartum coverage.