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MRG
UPDATED: JUNE 2010
709
OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY
PREGNANT WOMEN
The local social services district will authorize Medicaid for the presumptively eligible woman. If the woman does not submit the required documentation by the date specified on the documentation checklist, without good cause, her presumptive case may be closed after appropriate notification.
Eligibility for pregnant women is determined as follows:
(a) If the net household income is equal to or less than 100% of the federal poverty level, the Medicaid level or Medicaid Standard (whichever is most beneficial), the woman and any infant under age one are fully eligible for all Medicaid services.
(b) If the net household income is above 100% of the federal poverty level and does not exceed 200% of the federal poverty level, the woman is eligible for ambulatory Medicaid prenatal care services and any infant under age one is fully eligible for all Medicaid services. If the net household income exceeds 200% of the federal poverty level, the pregnant woman is referred to the local social services district to determine eligibility for Medicaid under the "spenddown" provisions.
Disposition: A pregnant woman may be determined presumptively eligible for Medicaid. The provider completes a preliminary assessment of the woman's income and establishes her eligibility based on Department guidelines. If the woman's income is less than 100% of the federal poverty level, she is eligible for all ambulatory Medicaid services. When the income is above 100% but less than or equal to 200% of the poverty level, the pregnant woman is eligible for ambulatory prenatal care Medicaid services only. For the pregnant woman to continue her coverage past the period of presumptive eligibility, she submits the required documentation to the local social services district. Only one period of presumptive eligibility is allowed per pregnancy.
Presumptive Medicaid eligibility begins on the date the provider determines presumptive eligibility. This is usually the date of the pregnant woman's first visit or the date services were first rendered to her. This is also the date of application for on-going Medicaid. Presumptive eligibility continues until a finding of eligibility is made or if the woman does not file a Medicaid application, until the last day of the month following the month after the woman was first found to be presumptively eligible.