Medicaid Policy
Medicaid Policy
A. General Rules
Determine the household’s countable income according to the following rules.
1. Identify whom to include in the Pregnant Woman Medically Needy household (404-2).
2. Count income of both spouses.
3. 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 without having to meet the spenddown again. See policy 205-6 for Emergency Medicaid.
· The amount of the spenddown cannot exceed the amount determined for the first Medically Needy program the member was eligible for while pregnant even though there may be an increase in income.
· The spenddown may be decreased if income decreases.
4. Policy prohibits the deeming of a child's income and assets to a parent.
a. All children, as applicable, are counted in the household size along with their parent(s).
b. Any income and assets of a child is not counted for the Medically Needy Pregnant Woman program.
B. Income Calculation for Pregnant Woman Medically Needy
Use the following method to calculate the countable income.
1. Subtract the earned income disregards according to the rules in 431-3 from each employed person's countable earned income (441-1).
2. Add the household’s countable unearned income (415 and 417).
3. The countable income is the remaining income after subtracting the allowable deductions (431-3).
4. Compare the countable income to the BMS (Basic Maintenance Standard) for the household size (Table VII).
a. If the countable income does not exceed the BMS for the household size, the household is eligible for Pregnant Woman Medically Needy with no spenddown. (This may happen when the household countable income is more than the BMS, but deductions like health insurance premiums reduce the income to below the BMS.)
b. If the countable income exceeds the BMS for the household size, the household may spenddown (461).
c. Subtract the BMS for the household size from the countable income to determine the spenddown (461).
5. Determine eligibility using actual income received in any of the retroactive months in which the individual was pregnant.