Page 43

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 July 2022 Subchapter Subject Page ending with Page M0310 GENERAL RULES & PROCEDURES M0310.125 36

The definition of “pregnant woman” for the purposes of the eligibility determination and covered group designation is met for 12 months following the last day the woman was pregnant regardless of the reason the pregnancy ended, and continues to be met until the last day of the month in which the 12th month occurs. After a woman’s eligibility as a pregnant woman is established for Medicaid or FAMIS MOMS, her entitlement continues for 12 months following the end of the month in which her pregnancy ends, regardless of income changes. Medicaid and FAMIS MOMS coverage ends the last day of the 12th month. B. Procedures 1. No Further Verification of Pregnancy Required If the woman has indicated on the application that she is pregnant or subsequently reports a pregnancy, no further information regarding her pregnancy is to be requested nor verification is to be required unless the agency has reason to question the applicant’s statement that she is pregnant. If a woman is applying after the end of a pregnancy, her report of the birth or pregnancy end date is sufficient to establish (1) for purposes of retroactive coverage, her pregnancy in the three months prior to the child’s birth month or pregnancy end date, or (2) for purposes of new, prospective coverage through the end of the 12-month postpartum period, her pregnancy in the twelve months prior. 2. Covered Groups Eligibility A pregnant woman may be eligible for Medicaid if she meets all of the Medicaid eligibility requirements including any one or more of the covered groups. Once eligibility is established in any covered group, changes in income do not affect her eligibility as long as she continues to meet the definition of a pregnant woman and all non-financial eligibility requirements. See section M0330.400 for the pregnant woman covered group requirements and M0330.801 for the MN Pregnant Woman requirements.

M0310.125 QDWI

A. Qualified Disabled & Working Individuals (QDWI) QDWI is the short name used to designate the Medicaid covered group of Medicare beneficiaries who are "Qualified Disabled and Working Individuals." A qualified disabled and working individual means an individual • who is entitled to enroll for Medicare Part A, • whose resources do not exceed twice the maximum amount of resources that an individual or couple may have and be eligible for SSI, • whose income does not exceed 200% of the federal poverty limit, • who is NOT otherwise eligible for Medicaid.