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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 April 2026 Subchapter Subject Page ending with Page M0330.000 FAMILIES & CHILDREN GROUPS M0330.400 15

For example, a married pregnant woman applies for Medicaid on October 10. She received a medical service in the retroactive period. Her expected delivery date is January 15. She and her husband have been unemployed since June 23. Her husband began earning $3,000 a month on October 9; she remains unemployed. Since they had no income during the retroactive period, she is found eligible for retroactive coverage effective July 1. Because her available income (from her husband) changed after she established eligibility on July 1, the change in income does not affect her eligibility and she remains eligible for Medicaid in October and subsequent months until she no longer meets the pregnant woman definition or other nonfinancial requirements. b. Newborn Income changes do NOT affect the certain newborn’s eligibility for the first year of the child’s enrollment as a certain newborn. The mother’s failure to complete a renewal of her own eligibility and/or the eligibility of other children in the household does NOT affect the eligibility of the certain newborn. 5. Income Exceeds Limit If the pregnant woman’s income exceeds the 143% FPL limit, she is not eligible in this covered group. Determine her eligibility for FAMIS MOMS. If the pregnant woman is not eligible for FAMIS MOMS, evaluate her eligibility as MN (see M0330.801). Ineligible women, other than incarcerated women, must be referred to the Health Insurance Marketplace for evaluation for the APTC. D. Entitlement Eligible pregnant women are entitled to full Medicaid coverage beginning the first day of the individual’s application month if all eligibility requirements are met in that month. Retroactive coverage is applicable to this covered group if the woman was pregnant during the retroactive month(s). The newborn’s Medicaid coverage begins the date of the child’s birth. A renewal must be completed for the newborn in the last month in which the child meets the Newborn Children Under Age 1 covered group and must include SSN or proof of application, as well as verification of income. Eligible pregnant women and newborns are entitled to all Medicaid covered services as described in chapter M18. After her eligibility is established as a pregnant woman, the woman’s Medicaid entitlement continues for 12 months following the end of the month in which her pregnancy ends (with birth or for any reason), regardless of income changes. Medicaid coverage ends the last day of the 12th month. If a Medicaid or FAMIS MOMS recipient who applied effective November 1, 2021 [or a CHIPRA214 (lawfully residing individual) who applied effective April 1, 2022] whose pregnancy has ended reapplies for coverage after July 1, 2022, she is entitled to the remainder of the 12 month post-partum period she would have received had her coverage not been canceled. E. Enrollment The AC for pregnant women who are not incarcerated is 091. The AC for pregnant women who are incarcerated is 109. The AC for newborns born to women who were enrolled in Medicaid is 093.