CHAPTER 6:  PREGNANCY

INTRODUCTION   6.1

 

Pregnancy can affect what benefits an individual may receive or what program requirements they must follow.  For example, if a minor is pregnant and is expected to deliver within the next four months she is ineligible for GC; instead, the SSR should determine if she is eligible under TANF.  In addition, pregnant women may face different income tests in Medicaid.  This chapter details the adjustments that must be made for a pregnant applicant.  Pregnancy does not affect eligibility determinations for FS.  This chapter only applies to MA, TANF, and GC.

 

 LEGAL AUTHORITY   6.2

 

AREA/TOPIC	DISTRICT	FEDERAL
Pregnant Women	D.C. Code:  4-205.43	MA:  42 USC 1396a(e)(4)-(6); 42 USC 1396a(1); 42 USC 1396d(a) (10); 42 USC 1396r-1; 42 USC 1396u-1; 42 CFR 435.116; 42 CFR 435.117; 42 CFR 435.170   TANF:  42 USC 608 (a)(1)

 

ELIGIBILITY  6.3

 

MA	A woman is eligible for Medicaid under the AR/AX program types once pregnancy has been confirmed.   When determining the eligibility of a pregnant woman or a group that includes a pregnant woman, take into account the needs, income, and resources of: the pregnant woman, the unborn child (or children when it is medically verified that there is more than one fetus), the unborn child's father if he is living in the home (the father can not be in the group until the child is born), and  eligible siblings. The needs, income, and resources of the unborn child are considered as though the child (or children) were born and living with the mother (see Section 6.5:  Presumptive Eligibility for Pregnant Women  for information on presumptive Medicaid eligibility for pregnant women). Example Ms. Brady is pregnant.  She has no other children and does not live with the unborn child's father.  When assessing program eligibility for Ms. Brady, her income will be compared to the income-eligibility standard for a family of two.
TANF	A woman who is pregnant and presents medical certification that she is expected to deliver within the next four months is eligible for TANF benefits, even if she has no other children in her household.
GC	If a non-related caretaker applies for financial benefits for a pregnant minor who is not expected to deliver within 4 months, the application should be processed under the GC program. When a pregnant minor is expected to deliver within 4 months, she is eligible for TANF provided she meets all other financial and non-financial eligibility requirements for TANF.  In this case no GC application should be taken.

 

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