0925.010.25  Need (MPW)

Section 1902(a)(17)(D) of the Social Security Act prohibits the consideration of income of persons not financially responsible for an individual. All MHF budgeting methodologies apply to MO HealthNet for pregnant women except:

• Assistance grouping rules,
• The $50 child support disregard is not allowed, and
• Stepparent deeming.
• SSI income of assistance group members is included, refer to Section 0925.010.25.15.

Definitions of income and income exclusions are the same as MO HealthNet for non-CHIP children unless otherwise stated.

NOTE:  MPW follows the same budgeting methodology as MO HealthNet for Families (MHF) when deeming a major parent’s income to a minor parent.  Refer to Section 0905.012.20.

0925.010.25.05  Income Limits (MPW)

A pregnant woman is eligible for MO HealthNet healthcare coverage if the assistance group's net income does not exceed 185% of the federal poverty level (FPL) for the household size (including the unborn child(ren)).

Eligibility for the MO HealthNet for Pregnant Women program should be explored using the MHF net income standard (current Temporary Assistance grant amount limit) before using the 185% federal poverty level need standards. The reason for this is the State has the authority to be more restrictive in regard to medical services provided to pregnant women with income higher than MHF levels. At this time, coverage is the same, it is not restricted. However, if services are restricted in the future, these individuals will need to be identified. Thus, eligibility is to be explored by comparing the assistance group's income to the MHF need standards first.

Note: Do not disregard the first $50 of child support when determining eligibility for MPW using the MHF need standards.

If income exceeds the MHF limit compare the assistance group's income to 185% of the FPL for the family size.

0925.010.25.10  Assistance Group (MPW)

Some family members are mandatory for inclusion in the assistance group and some are optional. Others are mandatory for exclusion. Determine the assistance group by including mandatory members, and optional members whose inclusion does not adversely effect eligibility. Mandatory exclusions take precedence over the mandatory inclusions for assistance grouping.

1. Assistance Group Mandatory Persons Included (MPW)

The following persons must be included in the assistance group, unless they are a mandatory exclusion:

• the pregnant woman
• the unborn child
• the unborn child's father (if in the home)

NOTE:  If a multiple birth is verified, include the additional unborn child(ren).

2. Assistance Group Mandatory Exclusions (MPW)

The following persons must be excluded from the assistance group:

• a married child whose spouse is in the home
• sanctioned individuals (the income of a parent is included)

The pregnant woman has the option to include the following persons in the assistance group, unless they are a mandatory exclusion:

• age-eligible siblings (full, half, step, adoptive) of the unborn child
• spouse of the pregnant woman (if not the father of the unborn child)

NOTE: Do not include optional assistance group members whose income causes ineligibility.

0925.010.25.15  SSI/SAB Income (MPW)

This requirement is the same as for MC+ for children. Refer to Section 0920.010.35.10 .