B-7120 Pregnancy and 12-Month Postpartum Coverage After SSI Denial

Revision 24-4; Effective Dec. 1, 2024

Pregnant and postpartum women will automatically transition to Medicaid for Pregnant Women (TP 40) for the remainder of their pregnancy and the 12-month postpartum period if:

they received Supplemental Security Income (SSI) Medicaid while pregnant; and

lose ongoing eligibility for SSI.

A new TP 40 EDG is created without an application for pregnancy Medicaid. A full redetermination of eligibility must occur at the end of the TP 40 certification period.

Continuous Medicaid and CHIP coverage is provided through the pregnancy and the 12-month postpartum period regardless of any change in circumstance unless the woman:

voluntarily withdraws;

moves out of state;

dies; or

is ineligible due to agency error, fraud, abuse or perjury attributed to the person.

Unverified Pregnancy

When a recipient loses SSI eligibility, and pregnancy information is received through an interface, the woman is automatically certified for TP 40 with postponed verification. Form H1020 , Request for Information or Action is sent. If verification is provided, the woman is eligible for TP 40 coverage through her pregnancy and postpartum period. If verification is not provided, or shows the woman does not meet eligibility requirements, TP 40 coverage is terminated unless the woman is under 19.