IM-#54 June 4, 2013, IM-#71 June 14, 2002

Women who are in need of family planning services and who are losing MO HealthNet for Pregnant Women (MPW) eligibility 60 days after their pregnancy ends remain eligible for coverage of women's health services. The coverage will continue for a maximum of one year after MPW eligibility expires. Eligibility automatically extends following the end of the 60-day postpartum period.
The woman must:

0925.050.05 Covered Women's Health Services (EWHS)

IM-#54 June 4, 2013, IM-55 May 10, 2002

Women in this category are eligible for a twelve-month period for the following services only:

There will be no cost sharing for this coverage. Services will be obtained fee-for-service through approved MO HealthNet providers in all areas of the state.

0925.050.10 Eligibility for Other MO HealthNet Programs (EWHS)

IM-#54 June 4, 2013, IM-#71 June 14, 2002

A woman receiving EWHS may qualify for another MO HealthNet program with more extensive coverage. If so, approve the other program and close the EWHS. Anytime the EWHS case is closed, the woman cannot regain eligibility for EWHS for the remainder of the one-year period.

If a woman becomes pregnant while the EWHS case is active it is necessary to register a new MPW application. FAMIS closes the EWHS case upon approval of the MPW 2 case.

0925.050.15 No Longer in Need of Family Planning Services

IM-#54 June 4, 2013

If the Eligibility Specialist (ES) becomes aware that the participant is sterilized, take action to close after the 60 days postpartum has expired. Send the participant a Pre-closing Notice (IM-80PRE) stating the reason for the proposed action and giving the participant 10 days to respond. When the IM-80PRE expires, enter an action of adverse action worker close (AAWC) in FAMIS with the reason code APE – application approved in error and send the participant an Adverse Action Notice (IM-80) stating the correct reason for closing. A copy of this corrected letter must be filed in the case record.

EXAMPLE:  Ms. Jones delivers her child 03/25 by C-Section and notifies her ES that during her C-Section, she had her tubes tied. On 05/01 the ES sends Ms. Jones an IM-80PRE notifying her that her 60 days post partum coverage is coming to an end. On 05/11 the ES sends Ms. Jones an IM-80 informing Ms. Jones that her 60 days post partum will end on 05/31 and she was not found eligible for an additional MO HealthNet program.

0925.050.20  System Processes (EWHS)

IM-#54 June 4, 2013, IM-#71 June 14, 2002

EWHS recipients are identified on the FAMIS Medicaid Category History (MEDHIST) screen by Medicaid category EWHS and ME code 80.

FAMIS systematically converts women on MPW cases at the end of the 60-day postpartum period if the system reflects they are uninsured or are Health Insurance Premium Payment (HIPP) participants.

MO HealthNet for Pregnant Women (MPW) participants who have insurance coverage will continue to be systematically closed on the second payroll closing at the end of the 60-day postpartum coverage period.

EWHS will be systematically closed if a woman turns age 56 during the one-year extension period. EWHS coverage is date specific.

0925.050.20.05  Notification of Extension (EWHS)

IM-#54 June 4, 2013

A system-generated letter is sent to women eligible for Extended Women's Health Services. The notice explains changes in coverage and effective dates of coverage.

0925.050.20.10  Notification of Ineligibility for Extension Due To Insurance (EWHS)

IM-#54 June 4, 2013

The system will generate a letter to insured women advising when their postpartum coverage will end and the reason they do not qualify for the one year extension for women's health services. They are advised to notify their eligibility specialist immediately if they no longer have health insurance. If contacted by a participant who states they no longer have health insurance, update the appropriate screen in FAMIS, either Select Employer Sponsored Insurance (EMPINS/FM8m) OR Select Health Insurance (SELINS/FM8L) screen immediately so the case may be converted to EWHS.