400.17 PREGNANT WOMEN – (COE-088)

Refer to the history of pregnant women coverage in the overview chart shown above in 400.16. With the passage of the ACA, coverage of pregnant women at/below 185% FPL was converted to a MAGI-equivalent limit of 209% FPL effective January 1, 2014. Pregnant Woman Coverage Period The pregnant woman is covered by Medicaid from the month she is determined eligible through the 12-month post-partum period, regardless of any subsequent changes such as income or marital status. An application for pregnancy-related Medicaid may be filed prior to or after the birth of the child. If an application is filed after the birth of the child, it must be filed timely, i.e., by the end of the 3rd month following the child’s birth month, in order for the birth month to be considered for coverage. For example, a child is born in September. The mother has until the end of December to file a Medicaid application that could cover the month of September. Retroactive Medicaid may be requested for up to 3-months prior to the month the application is filed provided all eligibility criteria is met. Income is verified for the retroactive period for an ongoing eligible pregnant woman only if there is a change that must be considered, as explained in 201.04.01B, Requesting Paper Documentation at Application. The retroactive months may include post-partum months, depending on when the application was received. For example: A pregnant woman delivers her child September 15th and files a Medicaid application to cover the birth of the child on December 1st, requesting retroactive Medicaid for September – November. If eligible, the infant’s birth month of September.. Treat a request for pregnancy-related Medicaid coverage following a miscarriage the same as any other request for benefits for a pregnant woman. Post-partum coverage applies to the end of a pregnancy due to a miscarriage. The woman must report the early end of a pregnancy or early birth of a child that differs from her original due date in order to prevent possible overpayment of Medicaid claims. Post-partum Period Defined The 12-month post-partum coverage begins with the date the pregnancy ends and concludes at the end of 12- months following the end of the pregnancy. A case review is required at the end of the post-partum period. Refer to 101.18.03 for a discussion of ABD pregnant women and 101.19.02 for a discussion of MAGI-related pregnant woman transitioning to and from COE-088 for pregnancy-related coverage from COE’s that do not cover pregnancy. NOTE: A woman must be eligible in the birth month of the child, or the month pregnancy ended in order to be granted the extended post-partum period of coverage. Pregnant Woman in COE-075 Refer to 400.15.01, Pregnant Woman in COE-075, above for a discussion of placing low-income pregnant women in COE-075. Verification of Pregnancy Pregnancy is self-attested under the ACA. Request verification of pregnancy only if available information such as claims data conflicts with the self-attestation regarding pregnancy. NOTE: The pregnant woman’s Medicaid eligibility period, including her post-partum period (described in 400.17.03 below and also in 400.20) is determined by MEDS at the point COE-088 is approved.