Page 281

MRG

UPDATED: JUNE 2010

707

OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY

PREGNANT WOMEN

Policy: Presumptive eligibility is a means of immediately providing Medicaid services for prenatal care pending a full Medicaid determination. All Article 28 Pre-Natal Care providers and others as designated by the SDOH who have been trained must perform a preliminary assessment of a pregnant woman's income and provide application assistance if requested. Then, based upon guidelines established by the Department, s/he determines whether or not the woman is presumptively eligible for a limited array of medical services, based on income.

References: PHL

2529

Dept. Reg. 360-3.7(d)

ADM

90 ADM-9

INF

90 INF-45

LCM

95 LCM-106

GISs

00 MA/024

97 MA/028

95 MA/034

94 MA/016

91 MA/007

Interpretation: A pregnant woman is presumed eligible for limited Medicaid coverage when it is determined that the woman's income does not exceed 200% of the federal poverty level. The information used in the presumptive eligibility determination does not have to be verified. Pregnant women have the benefit of a larger “family size” by counting other family members (parents, stepparents, siblings, stepsiblings and half- siblings), whether or not they are applying. The income of such family members residing in the household is counted when determining the eligibility of pregnant women and children under the federal poverty levels, with two exceptions:

1. Public Assistance and SSI cash recipients and their income are invisible; and

2. The income/resources of parents are not considered in determining the income/resources available to a pregnant minor.