Page 1

ACA/FAMILY MEDICAID 201-2 ACA Pregnancy

Supersedes: FMA 201-2 (01/01/08) Reference: 42 CFR 435.116; ARM 37.82.101, 701; 42 USC 1396a and 42 USC 1396b Overview: Pregnant women who meet certain financial and nonfinancial criteria may be eligible for Medicaid coverage. Self-attestation is used as proof of pregnancy. Income must be at or below 157% of the Federal Poverty Level (ACA FMA 004 Table of Standards- ACA Pregnancy Income). If the due date is not provided, enter a date 9 months after the application date as the expected due date in the system. NON-FINANCIAL CRITERIA: Medicaid standard nonfinancial requirements are listed in section CMA 300 Non- Financial Overview. In addition to the standard criteria that applies to all Medicaid programs, the following non-financial criteria are specific to ACA Pregnancy: · Must be a pregnant woman CONTINUED COVERAGE: Pregnant women whose Medicaid (under non-pregnancy category) closes due to increase income may be eligible for continued Medicaid coverage through the end of their pregnancy. The woman must tell an eligibility staff member that she is pregnant prior to the effective date of closure. As long as the woman remains a Montana resident and continues to cooperate with TPL and Program Compliance, her Medicaid coverage will continue. To qualify for continued coverage, the woman must be eligible in the application month. If she is not eligible in the application month, continuous coverage begins with the first eligible month. The woman may be eligible for retroactive coverage, but retro months do not start a continuous coverage span. Effective Date: July 01, 2016