Budgeting Procedures for Pregnant Women 510-03-90-25

(Revised 6/1/2015 ML #3441)

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IM 5306

 

(N.D.A.C. 75-02-02.1-21)

 

 

The Omnibus Budget Reconciliation Act of 1990 provided for extended eligibility for pregnant women effective July 1, 1991.

 

When a pregnant woman becomes eligible for Medicaid, including during the three month prior period (THMP), she continues to be eligible, without regard to any increase in income of the ACA Medicaid Household, for sixty days after the day her pregnancy ends, and for the remaining days of the month in which the sixtieth day falls. Decreases in income, however, will be considered to further reduce any client share (recipient liability). All other Medicaid eligibility factors continue to apply.

• Self-attestation of a single-birth pregnancy is accepted unless it is questionable. Multiple births must be medically verified in order to increase the household size by more than one unborn child. Medical verification is a pregnancy determination made by medical personnel or a public health agency.
• For determinations made after the birth of the baby, the child’s birth verification may be used as verification of pregnancy.

 

When a woman applies for coverage and is pregnant, if eligible, she must be enrolled in Medicaid coverage as a pregnant woman, rather than in the new Adult Expansion Group.

 

When a woman is already enrolled in the Adult Expansion Group, and becomes pregnant after her enrollment, she must be informed of the benefits of moving to Medicaid coverage for pregnant women and given a choice to move to that coverage group.

• If the woman chooses Medicaid coverage as a pregnant woman, during the final month of the 60 free day period of eligibility, a review must be completed to evaluate whether she will remain eligible for Medicaid under another coverage group, including the Adult Expansion Group, or be referred to the Marketplace to choose an insurance policy. This will ensure there is no loss of coverage.
• If the woman chooses to remain covered under the Adult Expansion Group, the 60 free day period of eligibility does not apply. Thus a review will not need to be completed at that time.

 

When a Pregnant Woman becomes eligible and during her pregnancy a review is due, the Pregnant Woman must complete the review or her eligibility will end the last day of the month in which the review was due.

Exception: If a review is due within the 60 free days and is not completed, the pregnant woman remains eligible through the end of the month that the 60th day falls.

The individual must submit her review or reapply within 90 days to avoid a loss in coverage.

 

For policy relating to Extended Eligibility for Pregnant Women, refer to 510-03-45-05.