Family and Children's Medicaid MA-3240 PREGNANT WOMAN COVERAGE
A. Eligibility Rules for MPW
1. Be a citizen of the U.S. or a qualified alien who meets criteria contained in MA-3332, US Citizenship Requirements and/or MA-3330, Alien Requirements. Pregnant women who are non-qualified aliens or who are qualified aliens eligible for only emergency services are covered under MPW.
REVISED 08/01/13 – CHANGE NO. 04-13
2. Be a resident of North Carolina as defined in MA-3335, State Residence
3. Not be receiving assistance for her needs from another assistance category, county, or state.
4. Not be an inmate of a public institution with the exception that individuals incarcerated in a NC Department of Public Safety, Division of Prisons (DOP) facility have their eligibility placed in suspension. Refer to MA-3360, Living Arrangement.
5. Not be in an institution for mental disease except an individual under age 21 receiving inpatient psychiatric care. See MA-3360, Living Arrangement.
6. Provide verification of all health insurance coverage for herself and assign to the state all rights to third party payments from such insurance coverage.
7. Furnish her Social Security number(s) or apply for a number if she does not already have one. This does not apply to illegal aliens. See MA-3355 for enumeration requirements.
8. The pregnant woman must provide medical verification of her pregnancy.
a. Accept a written or verbal statement by a physician or other health professional. The statement must include:
(1) The length of the pregnancy as of the date of the statement. Ex. “Jane Doe is approximately 6 weeks pregnant.”
(2) Projected delivery date, month and year, sometimes referred to as "EDC" (estimated due date of confinement).
(3) Number of children expected. For budgeting purposes, if no number is indicated, assume that only one child is expected.
b. If application is made after the pregnancy ends, the child’s birth or death certificate may be used as verification of the woman’s pregnancy.
a. Income must be equal to or below 185% of the Poverty Income Level for the Needs Unit. Refer to MA-3310, MPW Budgeting.
b. Once eligibility is established, changes in income or family composition income do not affect eligibility.
REVISED 07/01/10 – CHANGE NO. 08-10
A pregnant woman receiving Medicaid as MPW is not required to cooperate with IV-D in establishing support for the unborn child or any other children receiving Medicaid or Work First for whom she is caretaker.
12. Emergency Medical Treatment Only
Non-qualified aliens and certain qualified aliens in the U.S. for less than 5 years are potentially eligible to receive MPW for emergency medical treatment only. Refer to MA-3330, Alien Requirements.
B. Procedures for MPW Coverage
1. Establish the assistance/budget/needs unit and financial need according to MA-3310, MPW Budgeting.
a. Verification of financial need for one calendar month establishes continuous financial eligibility throughout the pregnancy and post partum period.
b. Once financial need is verified for a calendar month, do not consider any subsequent change(s) in income or budget unit.
2. Advise the applicant of the following:
a. To report the birth of the baby or any termination of pregnancy (miscarriage, stillbirth, etc.) within 10 calendar days.
b. Automatic newborn coverage. See MA-3230, Eligibility of Individuals Under 21.
c. Post partum coverage.
d. Re-enrollment to determine eligibility as a caretaker after the 60 days postpartum period if she has children living with her or for any other aid program/category for which she may be eligible, such as MAD if she is disabled. If ineligible for other coverages, evaluate for Medicaid Family Planning Waiver (FPW).
REISSUED 07/01/10 – CHANGE NO. 08-10
C. Instructions for authorization:
1. Follow all application processing time standards in MA-3200-3217.
2. Classification is Categorically Needy. Aid Program/Category is MPW.
3. Establish the certification period according to MA-3425, Certification and Authorization.
a. Flag the case for review in the expected month of delivery by entering the month and year of delivery in the special review field.
b. Send an approval notice and authorize from the first day of the month in which all eligibility criteria are met through the last day of the month of the post partum period.
c. Do not redetermine eligibility until the end of the post partum period.
4. At the end of post partum period, complete a re-enrollment to evaluate for continued coverage under all aid program/categories. Refer to MA-3420, Re-Enrollment.