Page 1

ACA/FAMILY MEDICAID 201-12 Extended Postpartum Coverage

Supersedes: FMA 201-12 (7/01/2016) Reference: ARM 37.82.101, .701; 42 CFR 435.170; 42 CFR 435.116 Overview: Medicaid is extended toto provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid and CHIP. Individuals are entitled to the extended postpartum coverage regardless of the reason the pregnancy ends. Women receiving medically needy Medicaid receive the extended coverage if their spend down is met as of the delivery date. The mother must remain a Montana resident during the extended period; Medicaid is closed if she moves out of state. The 12-month postpartum period begins on the last day of a beneficiary’s pregnancy and extends through the end of the month in which the 12-month period ends. This continuous eligibility ends if the beneficiary: • is no longer a Montana resident; • does not cooperate with TPL and/or Program Compliance; • requests closure; • the Agency determines that eligibility was erroneously granted at the most recent determination or renewal of eligibility due to: a. Agency error or b. fraud, abuse, or perjury attributed to the beneficiary • the beneficiary dies. NOTE: When pregnancy coverage is provided under Emergency Alien Medical (CMA 301- 3 Emergency Alien), neither the newborn nor the mother qualify for extended pregnancy coverage. The newborn may be eligible for other coverage (e.g., Child-Newborn, HMK Plus, etc.). RECEIVING MEDICAID:

loading…

Page 1

Official source

ACA/FAMILY MEDICAID 201-12 Extended Postpartum Coverage

Supersedes: FMA 201-12 (7/01/2016) Reference: ARM 37.82.101, .701; 42 CFR 435.170; 42 CFR 435.116 Overview: Medicaid is extended toto provide 12 months of extended postpartum coverage to pregnant individuals enrolled in Medicaid and CHIP. Individuals are entitled to the extended postpartum coverage regardless of the reason the pregnancy ends. Women receiving medically needy Medicaid receive the extended coverage if their spend down is met as of the delivery date. The mother must remain a Montana resident during the extended period; Medicaid is closed if she moves out of state. The 12-month postpartum period begins on the last day of a beneficiary’s pregnancy and extends through the end of the month in which the 12-month period ends. This continuous eligibility ends if the beneficiary: • is no longer a Montana resident; • does not cooperate with TPL and/or Program Compliance; • requests closure; • the Agency determines that eligibility was erroneously granted at the most recent determination or renewal of eligibility due to: a. Agency error or b. fraud, abuse, or perjury attributed to the beneficiary • the beneficiary dies. NOTE: When pregnancy coverage is provided under Emergency Alien Medical (CMA 301- 3 Emergency Alien), neither the newborn nor the mother qualify for extended pregnancy coverage. The newborn may be eligible for other coverage (e.g., Child-Newborn, HMK Plus, etc.). RECEIVING MEDICAID: