IMA POLICY MANUAL PART IV: NON-FINANCIAL ELIGIBILITY REQUIREMENTS
PROGRAM REQUIREMENTS 6.4
MA
Pregnant women are not required to cooperate in establishing paternity and obtaining medical support for either their unborn child or other children in their families.
All other non-financial eligibility factors applicable to the MA program must be met by pregnant women, including:
residence
citizenship or alienage
SSNs
assignment of third-party liability rights
utilization of potential benefits.
TANF
In order to receive benefits, a pregnant minor (under age 18) expected to deliver within the next four months must reside in her parent’s home or, if that option is unavailable, in the home of another adult relative or responsible adult (unless the Department determines that no appropriate such living arrangement exists). If the pregnant teen is married, then s/he is not required to live in an adult-supervised setting, even if the teen is not residing with her spouse. This requirement also applies to minor custodial parents (see Section 1.12: Requirement that Minor Parent Live in an Adult-Supervised Setting in this Part for more information).
In addition, an unmarried pregnant teen must attend high school or an equivalent educational, training, or other similar program approved by the Department unless she has good cause for failing to meet the requirement. This requirement does not apply if she is married, even if she is not living with her spouse, or if she has already obtained a high school diploma or GED certificate. Unmarried parenting teens are also subject to this requirement (see Section 4.4.1: Teen Parent School Attendance Requirement in this Part for more information).
GC
N/A
PRESUMPTIVE ELIGIBILITY FOR PREGNANT WOMEN 6.5
MA
Presumptive eligibility is available to pregnant women whose family income does not exceed 200 percent of FPL while ongoing eligibility for MA is determined. Selected qualified medical providers (QMP) are authorized to make a presumptive eligibility determination based on preliminary information. Eligibility is established on the basis of pregnancy, family income, and family size (with the unborn child treated as a group member). The pregnancy must be medically verified. The pregnant woman's family income must not exceed 200 percent of the FPL.
The presumptive eligibility period begins on the day the QMP makes the presumptive eligibility determination. The pregnant woman is presumptively eligible until the last day of the month following the month she became presumptively eligible.
During the presumptive eligibility period, the pregnant woman is eligible for ambulatory prenatal services only. The services must be provided by a Medicaid provider. Delivery and hospitalization costs are not covered unless the woman is subsequently determined eligible for MA.
A presumptive eligibility period is limited to one presumptive determination per pregnancy. Individuals ineligible for MA due to immigration status are not eligible for a presumptive eligibility determination (see Chapter 7: Citizenship/Alienage in this Part).
TANF
N/A
GC
N/A
EXTENDED COVERAGE OF PREGNANT WOMEN 6.6
MA
Continue to provide all pregnancy-related and postpartum services to any woman (except non-qualified aliens) who was eligible for, applied for, and received MA while pregnant. The services continue for 60 days after the pregnancy ends beginning on the last day of pregnancy and ending on the last day of the month in which the 60th day falls.
Example
Ms. Bennett gives birth on May 20. Extended coverage begins on May 20 and ends on July 31.
Redetermine eligibility for an individual whose eligibility ends after the extended coverage period to determine if she and her family are eligible for continued services.
Individuals ineligible for MA due to immigration status are not eligible for extended benefits. Postpartum services are provided, however, as part of emergency pregnancy-related services for such immigrants.
The newborn is deemed eligible for one year (see Section 1.7: Adding a Newborn in this Part).
