If all eligibility requirements are met, the pregnant woman is eligible for MC+ healthcare coverage. If a second parent is in the home, he is not eligible for coverage under the MC+ For Pregnant Women Program.
Coverage begins with the first day of the month of application, provided the woman is subsequently found eligible. If obviously ineligible for the entire month of application and any subsequent months prior to approval, the coverage begins with the first day of the month in which eligibility was met.
The claimant must meet all eligibility factors during the prior quarter. If the claimant becomes eligible for assistance sometime during the prior quarter, eligibility for Title XIX begins on the first day of the month in which the claimant became eligible for assistance. The earliest date of MC+ healthcare coverage determined establishes continuous eligibility (refer to Section 0925.025.00.) from that date forward.
The effective dates of prior quarter coverage are no earlier than the first day of the third month prior to the month of application.
EXAMPLE: Ms. Y applies December 10. The doctor's statement of December 18 states Ms. Y's estimated due date is March 5. The earliest date of Title XIX coverage possible is September 1, even though Ms. Y became pregnant before September 1.The medical statement must indicate the estimated due date to determine if the claimant will be eligible for the entire prior quarter.
EXAMPLE: Ms. X applies October 4. The doctor's statement of October 16 states Ms. X's estimated due date is June 14. Based on the doctor's statement, the beginning date of pregnancy is September 14. The prior quarter coverage can begin no earlier than September 1.)
Pregnant women who are approved for MC+ healthcare coverage continue to be eligible during the postpartum period. (Refer to Continuous Eligibility, Section 0925.025.00.) MC+ healthcare coverage as a pregnant woman terminates on the last day of the month containing the 60th day after the termination of the pregnancy for women who apply while pregnant. The woman is not required to apply for another program to receive postpartum.
Eligibility for only postpartum coverage is not provided by law. To be eligible for postpartum coverage, the woman must have made application for MC+ healthcare coverage while pregnant and have been eligible, even though approval of the application might be after the birth of the child.
The postpartum ending date determined by expected delivery date is entered into field 32 of the IMU5 at the time of approval. Postpartum eligibility terminates on the last day of the month containing the 60th day after the termination of the pregnancy for women who apply while pregnant. The postpartum eligibility end date may be incorrect once we determine when the child is born. If we become aware of the birth prior to postpartum ending, make corrections to the ending date in field 32 based on the child's actual month of birth.
Example: Approved with postpartum date of February 29, 2004 entered in field 32 of the IMU5 as we verified an expected delivery date of December 20, 2003. Recipient did not delivery child until January 5, 2004. Therefore, postpartum ending date should be changed to March 31, 2004.
Example: Approved same as above. However, she delivered the baby November 30, 2003. The ending date should be changed to January 31, 2004.
If a woman applies for MC+ coverage as a pregnant woman after her pregnancy has terminated she may be eligible through the end of the month in which it terminated. Coverage would begin on the first day of the month of application or earliest month in the prior quarter in which she met all eligibility requirements. Due to continuous eligibility her MC+ healthcare coverage would continue through the last day of the month in which the pregnancy ended.