Medical Assistance for Families with Children and Adults

2.2.2.1.2 Pregnant Person Basis of Eligibility

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

Basis of Eligibility

The pregnant person basis of eligibility requires the person 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 person’s MA household. A pregnant person 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 other parent 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 the person 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 person eligible for MA under the pregnant person basis must have income at or below 278% FPG.

If income exceeds 278% FPG, an otherwise eligible MA pregnant person 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 person eligible for MA under the pregnant person basis must meet all other MA eligibility criteria, including citizenship and immigration requirements. A pregnant person 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 people or Emergency Medical Assistance are not required to provide a Social Security number or to verify their immigration status.

CHIP-Funded Pregnant Person

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

A pregnant person may be eligible for CHIP-funded MA if they:

Are undocumented or are a noncitizen ineligible for MA
Have income at or below 278% FPG. There is no spenddown eligibility under CHIP-funded MA.
Are 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.
Meet all other MA eligibility criteria, including state residency

Emergency Medical Assistance (EMA)

A pregnant person can be eligible for EMA coverage for labor and delivery costs or other medical emergencies if the person 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 person may be eligible for state-funded MA as a pregnant person 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 person 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 person does not want or is not eligible for retroactive coverage.

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

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

Change in Circumstances

Medical Assistance

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

For the person enrolled in MinnesotaCare who reports a pregnancy which results in MA eligibility under the pregnant person 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 person does not want or is not eligible for retroactive coverage.
Advanced Premium Tax Credits (APTC)

If a person enrolled on APTC reports a pregnancy that results in her becoming eligible for the MA pregnant person basis of eligibility, the person 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 person is continuously eligible for the pregnant person 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 person is exempt from renewal requirements through the end of the postpartum period.

Cost-Effective Health Insurance

Pregnant people 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 person.

Medical Support

A pregnant person, 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 person 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 person basis of eligibility for the duration of her pregnancy. However, if the person is receiving services through a waiver program,they must continue to use the disabled basis of eligibility through pregnancy and the postpartum period to retain her waiver services. A pregnant person who meets the disabled basis of eligibility may choose to be excluded from managed care enrollment.

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

Eligible as a pregnant person without a spenddown, the person’s eligibility must be changed to the Pregnant Person basis. At the end of her postpartum period, her eligibility should be redetermined for MA-BC.
Eligible as a pregnant person with a spenddown, the person may choose to remain eligible under a MA-BC basis or move to the pregnant person basis. If she chooses the pregnant person basis, their 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 People (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