Purpose: This section will assist in determining eligibility for Pregnant Women.

Current Policy Effective Date: July 1, 20 23

Date Last Reviewed: June 28, 2023

Previous Policy: J uly 1, 201 8

POL M1202A: DETERMINING ELIGIBILITY FOR PREGNANT WOMEN

1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors. Applicants must be a U.S. Citizen or a lawful present immigrant. Applicants residing in the U.S. under the Deferred Action Childhood Arrival (DACA) act are not eligible for this program.

2. Applicants Must Meet Income Requirements

Countable income must be less than or equal to 154% of the FPL. Refer to Medicaid Table 1 . Refer to Section M901 to determine if income is countable.

3. Applicants Do Not Have Resource Test

4. Benefits Begin The First Day Of The Application Month If Determined Eligible

Benefits begin on the first day of the application month, if eligible, and will continue through the 12 month postpartum period.

5. Applicants May Be Eligible For Retroactive Benefits

Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Both approved and denied applicants must be reviewed. Reviewer must verify and determine eligibility separately for each retroactive month to determine whether the case would have been eligible if an application had been made.

Retroactive benefits will not be authorized prior to the month pregnancy begins.

6. Non-Citizen Applicants Receive Limited Emergency Services

Pregnant women who are not a U.S. Citizen or a lawful present immigrant may receive emergency services, including labor and delivery. Refer to Emergency SVC Family & Children's Section M1205 for more information.

7. Clients Must Be Reviewed

Clients must be reviewed at the end of their 12 month postpartum period to determine continued eligibility under another Medicaid program to include Pregnant By Choice.

Send the Pregnant by Choice Questionnaire in the month of the estimated due date or upon notification of the baby’s date of birth. Have You Had Your Baby notice is sent 30 days after the due date when the birth of the child has not been reported.

Refer to Section M1403 for additional information on reviewing eligibility

8. Clients May Need To Cooperate With Child Support

Clients cannot be sanctioned during the 12 month post-partum period.

Unmarried women who give birth while on Medicaid will be required to cooperate with child support enforcement following the 12 month post-partum period, per birthing cost requirements in the statutes listed below.

9. Clients May Lose Benefits

Pregnant Women benefits will close on the first day of the next month when any of the following occur (Refer to Section M1404 for additional information on closing cases):

Client has moved out of state. Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston. Client dies. Client is determined no longer eligible. Client has not provided information on the date of birth of the newborn within the 12 month postpartum period.