Page 2

MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL

Division of Welfare and Supportive Services H-100 Medical Assistance Manual PRESUMPTIVE ELIGIBILITY 23 Oct 01 MTL 04/23 PRENATAL PREGNANCY PE

H-102 PRENATAL PREGNANCY PE

Prenatal Pregnancy PE can only be approved by a certified employee of a qualified provider. Pregnant individuals approved under this program are eligible to receive prenatal pregnancy care at outpatient clinics or other places in the community. PE for prenatal care provides limited services and will not cover the cost if you are admitted to a hospital. Questions on what specific services are or aren’t covered under this program should be directed to the DHCFP Provider Services unit.

H-103 HOSPITAL PE

Hospital PE can only be approved by a certified employee of a qualified hospital. Individuals and families approved under this program are eligible to receive immediate Medicaid services such as doctor visits, hospital care, and prescription drugs. They can go to any health care provider who accepts Medicaid starting the day you are approved. Questions on what specific services are or aren’t covered under this program should be directed to the DHCFP Provider Services unit.

H-105 ELIGIBLE GROUPS

Eligibility for medical assistance is categorized in groups based on the associated budget methodology used to determine eligibility.

An application for PE must contain the applicant’s name, address, and signature. See MAM D-100 for more information on acceptable applications and signatures.

Individuals applying for PE may designate anyone to act on their behalf by providing a signed written statement. If circumstances exist that render the individual incapacitated and unable to make that designation, a responsible adult family member or facility staff completing the application may designate themselves. See MAM A-120 for more information and restrictions on designating an Authorized Representative.

Individuals are eligible for 1 presumptive eligibility period in a 24- month period. Pregnant individuals are eligible for 1 presumptive eligibility period for each separate pregnancy.

a. Children o Under the age of 19; and o Children with household income that is at or below the FPL for the child’s age and applicable assistance unit.

1. Children 0 through 5 up to 165% (CH aid code) 2. Children 6 through 18 up to 122% (CH aid code) 3. Children 6 through 18 above CH up to 138% (CH1 aid code)