(Revised 10/1/13 ML #3390)
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IM 5306
(N.D.A.C. 75-02-02.1-21)
For Applications and Reviews received Prior to January 1, 2014 for benefits required prior to January 1, 2014:
The Omnibus Budget Reconciliation Act of 1990 provided for extended eligibility for pregnant women effective July 1, 1991.
When a pregnant woman, whose pregnancy has been medically confirmed, becomes eligible for Medicaid, she continues eligible, without regard to any increase in income of the Medicaid unit, 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). Likewise, a pregnant woman can move from one coverage type to another (e.g. from Family Coverage to poverty level); however, if poverty level eligible and income increases, the pregnant woman remains poverty level eligible. All other Medicaid eligibility factors continue to apply.
Pregnancy is medically confirmed if the woman confirms that she has been determined to be pregnant by medical personnel, a public health agency, or a home pregnancy test. Pregnancy must be medically confirmed for all eligibility determinations made during pregnancy, however, for determinations made after the birth of the baby, the child’s birth certificate may be used as verification of pregnancy.
For Applications and Reviews Received on or After October 1, 2013 for benefits beginning January 1, 2014:
The Omnibus Budget Reconciliation Act of 1990 provided for extended eligibility for pregnant women effective July 1, 1991.
When a pregnant woman under becomes eligible for Medicaid, she continues eligible, without regard to any increase in income of the Medicaid unit, 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. After January 1, 2014, only pregnant women under 19 will have a client share (recipient liability).
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 certificate may be used as verification of pregnancy.
