Medical Assistance for Families with Children and Adults

2.2.2.1.2 Pregnant Woman Basis of Eligibility

A woman who is pregnant or within the postpartum period may be eligible for Medical Assistance under the pregnant woman basis of eligibility.

Basis of Eligibility

The pregnant woman basis of eligibility requires the woman to:

  • Be pregnant or within the postpartum period

  • Meet all other MA eligibility criteria.

Attestation of pregnancy establishes this basis of eligibility.

Household Composition

Unborn children are counted in the family size of a pregnant woman’s MA household. A pregnant woman is counted as two or more, depending on the number of unborn children she is expecting. Eligibility must be redetermined for the entire household upon a report of pregnancy. 

The father of an unborn child is not eligible under the Parent basis of eligibility until the month the child is born, unless he is already eligible under the parent basis due to having another child in the household.

A child born to a mother eligible for and enrolled in MA in the birth month is automatically eligible for MA as an auto-newborn from the date of birth until the last day of the month of their first birthday.

Income and Spenddown Eligibility

A woman eligible for MA under the pregnant woman basis must have income at or below 278% FPG.

If income exceeds 278% FPG, an otherwise eligible MA pregnant woman may qualify for MA with a spenddown. See Medical Assistance for Families with Children and Adults Medical Spenddown for more information.

Sponsor deeming does not apply when the sponsored noncitizen is pregnant or within the 12 month postpartum period. See Medical Assistance for Families with Children and Adults Sponsor Deeming for more information.

MA for Pregnant Noncitizens Not Otherwise Eligible for Medical Assistance

A woman eligible for MA under the pregnant woman basis must meet all other MA eligibility criteria, including citizenship and immigration requirements.  A pregnant woman who is not lawfully present may be eligible for CHIP-Funded MA or Emergency Medical Assistance.

People applying for, or enrolled in, CHIP-funded MA for pregnant women or Emergency Medical Assistance are not required to provide a Social Security number or to verify their immigration status.

CHIP-Funded Pregnant Woman

Children’s Health Insurance Program (CHIP) funded MA is available for pregnant women who are undocumented or are noncitizens not otherwise eligible for MA.  Like MA for pregnant women, CHIP-funded MA is available from the month of conception through the postpartum period.

A pregnant woman may be eligible for CHIP-funded MA if she: 

  • Is undocumented or is a noncitizen ineligible for MA

  • Has income at or below 278% FPG. There is no spenddown eligibility under CHIP-funded MA.

  • Is not enrolled in other health care coverage. Access to or the availability of other health insurance, such as insurance through an employer, is not a barrier to CHIP-funded MA. An applicant or enrollee is ineligible for CHIP-funded MA only if she is enrolled in other health coverage.

  • Meets all other MA eligibility criteria, including state residency

Emergency Medical Assistance (EMA)

A pregnant woman can be eligible for EMA coverage for labor and delivery costs or other medical emergencies if the woman is not lawfully present and is ineligible for CHIP-funded MA, either due to having other health care coverage or due to excess income. EMA is available with a spenddown.

EMA coverage for labor and delivery costs does not include a postpartum period.

State-Funded MA

A woman may be eligible for state-funded MA as a pregnant woman if she is ineligible for MA or CHIP-funded MA, but is receiving services at the Center for Victims of Torture.

Eligibility Begin Date

Application

For an applicant, MA eligibility as a pregnant woman begins the first day of the month of conception, but no earlier than three months prior to the month of application.  It can begin no earlier than the first day of the month of application if the pregnant woman does not want or is not eligible for retroactive coverage. 

A woman may apply under this basis during or after her pregnancy. An application for a pregnant woman must be processed within 15 days.

Even if a woman is not eligible for MA in the birth month, she may be eligible under this basis for the postpartum period only.

Change in Circumstances

  • Medical Assistance

    For a woman enrolled in MA who reports a pregnancy, eligibility under the pregnant woman basis begins the first day of the month of conception.

  • MinnesotaCare

    For a woman enrolled in MinnesotaCare who reports a pregnancy which results in MA eligibility under the pregnant woman basis, MA eligibility begins no earlier than three months prior to the month she reported the pregnancy. It can begin no earlier than the first day of the month she reported the pregnancy if the pregnant woman does not want or is not eligible for retroactive coverage.

  • Advanced Premium Tax Credits (APTC)

    If a woman enrolled on APTC reports a pregnancy that results in her becoming eligible for the MA pregnant woman basis of eligibility, the woman may choose to move to MA or to continue receiving APTC. Eligibility for MA begins the first day of the month she reported the change, with up to three months MA eligibility prior to the month she reported the pregnancy.

Eligibility End Date

A pregnant woman is continuously eligible for the pregnant woman basis of eligibility until the end of the postpartum period, regardless of any income changes.  The postpartum period:

  • Begins the day the pregnancy ends. Pregnancy ends on the date of a birth, miscarriage, abortion, or stillbirth.

  • Ends the last day of the month 12 month after the pregnancy ends.

Post-Eligibility

Renewal

A pregnant woman is exempt from renewal requirements through the end of the postpartum period.

Cost-Effective Health Insurance

Pregnant women with access to a cost-effective group health plan through their employer must enroll in that coverage as a condition of MA eligibility, with the exception of CHIP-funded pregnant women.

Medical Support

A pregnant woman, or a parent or relative caretaker who is pregnant, is not required to cooperate with medical support for any child during the pregnancy and postpartum period. 

Change in Basis of Eligibility

A change in circumstances may affect an enrollee’s basis of eligibility.

A woman who is pregnant and also eligible for MA using the blind or disabled basis of eligibility may choose to continue receiving MA services under that basis, or she may choose to move to the pregnant woman basis of eligibility for the duration of her pregnancy. However, if the woman is receiving services through a waiver program, she must continue to use the disabled basis of eligibility through pregnancy and the postpartum period to retain her waiver services. A pregnant woman who meets the disabled basis of eligibility may choose to be excluded from managed care enrollment.

If a woman enrolled in Medical Assistance for Women with Breast or Cervical Cancer (MA-BC) becomes pregnant, and is:

  • Eligible as a pregnant woman without a spenddown, the woman’s eligibility must be changed to the Pregnant Woman basis. At the end of her postpartum period, her eligibility should be redetermined for MA-BC.

  • Eligible as a pregnant woman with a spenddown, the woman may choose to remain eligible under a MA-BC basis or move to the pregnant woman basis. If she chooses the pregnant woman basis, her eligibility for MA-BC must be redetermined at the end of the postpartum period.

Legal Citations

Centers for Medicare & Medicaid Services (CMS) State Health Officials letter re: Minimum Essential Coverage (Nov. 7, 2014), at https://www.medicaid.gov/federal-policy-guidance/downloads/sho-14-002.pdf 

Centers for Medicare & Medicaid Services (CMS) State Health Officials letter re: Medicaid and CHIP Coverage of “Lawfully Residing” Children and Pregnant Women (July 1, 2010), at www.cms.gov/smdl/downloads/SHO10006.pdf

Code of Federal Regulations, title 42, section 435.116

Code of Federal Regulations, title 42, section 435.117

Code of Federal Regulations, title 42, section 435.170

Code of Federal Regulations, title 42, section 435.956

Minnesota Statutes, section 256B.055, subdivision 6

Minnesota Statutes, section 256B.057, subdivision 1

Minnesota Statutes, section 256B.06, subdivision 4 & 5