Medicaid Policy                                                                 

349 Pregnant Woman Category

Effective Date: January 1, 2024

Previous Policy

Resource - Household Summary for Family Related Medicaid Programs

 

Determine eligibility for pregnant individulals first on the Parent Caretaker Relative program, as it allows for the possibility of continued benefits on the 12-Month Transitional program (343).  If not eligible for the Parent Caretaker Relative, determine eligibility for Pregnant Woman.

Use the MAGI methodology to determine the household size for the Parent Caretaker Relative and the Pregnant Woman programs (401).  See 440 for the MAGI financial requirements.

 

A.   Non-Financial Requirements

 

1.       Verify pregnancy by client statement

·       Accept multiple-birth verification by client statement.

2.       There is no medical support enforcement requirement during the pregnancy and through the postpartum period (227-1).

3.       The individual must meet citizenship/non-citizen status requirements and state residency requirements (205 and 207). 

 

B.   Eligibility Period

 

1. A pregnant member who would otherwise lose Medicaid coverage due to a change in circumstances is protected through the end of the 12 month postpartum period, as long as she still resides in Utah and has not entered a public institution.

2.       A member who becomes pregnant while covered under a different program (other than Hospital Presumptive or Emergency Medicaid programs) continues to be eligible for pregnant woman coverage through the end of the 12 month postpartum period. If the Individual is eligible for a medically needy program when she becomes pregnant, evaluate her for poverty-level pregnant woman coverage.

3.       If a pregnant member turns 19 while on a Child program, move her to a Pregnant Woman or Parent Caretaker Relative program.

4.       When an individual applies for Medicaid while pregnant, or after giving birth, determine if she was eligible for a MAGI-Based Child, Pregnant Woman or Parent Caretaker Relative program.

a.       To determine what month to begin an applicant’s coverage, see 705.

b.       If an applicant is determined eligible for coverage during a month in which she was pregnant, continue coverage through the end of the 12 month postpartum period.

c.       At the end of the 12 month postpartum period, conduct an eligibility review (721) to determine the individual’s eligibility for continued Medicaid coverage (827) under a different program. 

5.       A pregnant, lawfully-present child (205-2.1) will lose Medicaid eligibility when she turns age 19 if her non-citizen status has not changed to a qualified non-citizen status as defined in 205-2, or she has not become a citizen. Check the individual’s non-citizen status to see if she has become a qualified non-citizen or US citizen.

·       If she is not eligible for full Medicaid services approve the member for State CHIP for the remainder of her pregnancy and postpartum period..

6.       See 347 for policy regarding a child born to a Medicaid mother.

 

C.   Medically Needy

 

1. Determine Medically Needy Pregnant Woman for a pregnant individual only if she does not qualify for coverage under any other Medicaid program and has failed the income test under the MAGI-Based Pregnant Woman or Parent Caretaker Relative program.
   1. A pregnant member that meets a spenddown at any point during their pregnancy is entitled to continue to receive coverage through the remainder of their pregnancy and postpartum period.  

2.       If the member is eligible for and receiving a Medically Needy program when she becomes pregnant, evaluate her for a MAGI program.

a.       If eligible, move her to that program.

b.       If ineligible, evaluate her for Medically Needy Pregnant Woman.  The pregnant member will not need to meet another spenddown through the remainder of the pregnancy and postpartum period.

3.       Determine the income eligibility for Pregnant Woman Medically Needy using the following sections:   435, 404-2, 441-3.

4.       Asset rules for Medically Needy Pregnant Woman are the same as for Family Medically Needy (503, 503-2 & 521-4).  

5.       See 731-3 for policy about when to accept client statement as verification of assets.

6.       See 227-1 for the Medical Support Enforcement rules for pregnant women.