Family and Children's Medicaid MA-3240 PREGNANT WOMAN COVERAGE

III. MAF

A. Eligibility Rules Specifically Applicable To Pregnant Women Under MAF

1. The pregnant woman must meet the regulations in II.A.1-8, and

2. Income

Be in financial need according to regulations in MA-3305, M-AF, M-IC, H-SF Budgeting, for the appropriate number in the needs unit.

3. Resources

Not have resources in excess of the resource limit defined in MA-3320, Resources.

4. IV-D

Cooperate with the local child support agency in establishing paternity and receiving child support for any children (other than the unborn child) who are receiving Medicaid and for whom she is the caretaker.

REVISED 06/01/07 – CHANGE NO. 09-07

(III.)

B. Procedures For Coverage Of Pregnant Women Under MAF

1. Establish assistance/budget/needs unit and financial need according to MA-3305, M-AF, M-IC, H-SF Budgeting.

2. Advise the pregnant woman of the following:

a. To report the birth of the baby or other termination of pregnancy (miscarriage, stillbirth, etc.) within 10 days.

b. Automatic newborn coverage. See MA-3230, Eligibility of Individual Under Age 21.

c. Post partum coverage.

d. Evaluation for continued coverage under MPW if she loses eligibility for MAF.

e. 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).

C. Instructions for Authorization

1. Follow all application processing time standards in MA-3200-3217.

2. Classification is Categorically Needy or Medically Needy. Aid Program/Category is MAF.

Note: Pregnant women can only be MAF-N or MAF-M. They cannot be MAF-C.

3. Establish the certification/authorization period according to MA-3425, Certification and Authorization.

a. 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 certification period.

b. Flag the case for review in the month of expected delivery by entering the expected month and year of delivery in the special review field.

c. If a woman is covered under pregnant woman coverage in MAF and it is learned that she is expecting to deliver more children than first known, adjust the budget unit effective the month in which the change is reported.

REVISED 06/01/07 – CHANGE NO. 09-07

(III.C.)

4. At the end of the postpartum period, conduct a re-enrollment to evaluate for continued coverage under all aid program/categories. Refer to MA-3410, Terminations and Deletions, V.C.1., and MA-3420, Re-Enrollment.