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MRG

UPDATED: JUNE 2010

708

OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY

PREGNANT WOMEN

The following deductions from income are allowed: $90 from earned income; child care from employment income; $100 from child support received; and health insurance premiums, if not already deducted from the wages. (See INCOME LIF BUGETING METHODOLOGY $90 WORK EXPENSE DISREGARDS and INCOME ADC-RELATED BUDGETING METHOLDOLOGY CHILD/INCAPCITATED ADULT CARE COST and INCOME ADC-RELATED DISREGARDS and INCOME HEALTH INSURANCE PREMIUMS) All resources are disregarded.

When the pregnant woman's family income is equal to or less than 100% of the federal poverty level, she is presumptively eligible for all care, services and supplies available under the Medicaid program.

When the pregnant woman's family income exceeds 100% of the poverty level, but does not exceed 200%, she is presumptively eligible for Medicaid covered ambulatory prenatal services only.

The Article 28 Pre-Natal Care provider or others designated by SDOH:

• completes the screening checklist at the first visit to determine the applicant's presumptive eligibility;

• assists the pregnant woman in completing the standard application for assistance and assist her with choosing a health plan;

• advises a presumptively eligible woman of her responsibility to complete the Medicaid application process;

• forwards screening checklist and Medicaid application to the appropriate local social services district within five working days; and

• provides the pregnant woman with a copy of the checklist and notice of presumptive eligibility determination.

Outreach sites that are not Article 28 Pre-Natal Care providers or other providers designated by the SDOH are not able to authorize presumptive eligibility.