*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: June 1, 2012 |
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03.15 - Enrollee Becomes Pregnant |
Archived: June 1, 2016 (Previous Versions) |
Minnesota Health Care Program enrollees who become pregnant will most likely experience a change in eligibility group, basis of eligibility, or MPET.
MinnesotaCare Enrollee Becomes Pregnant.
Effect of Pregnancy on MinnesotaCare Eligibility.
Medical Assistance (MA) Enrollee Becomes Pregnant
If a woman becomes pregnant while receiving MA under any basis of eligibility:
l Change her MA eligibility to a pregnant woman basis from the month of conception through the 60-day postpartum period.
l Require verification of pregnancy; see MA for pregnant women for further information about verification requirements.
l If you receive a report of a pregnancy-related health services claim through MMIS, request further information from the client.
Women receiving MA using a Method B basis of eligibility such as blindness or disability who become pregnant may choose to continue using the Method B basis. Explain to the woman that the pregnant woman basis has a higher income standard. Flag the case to ensure that MA remains open if the woman becomes ineligible for MA using Method B.
Exception: Women receiving services through the waiver programs must continue to use a disabled basis of eligibility during the pregnancy and postpartum period.
Note: The husband of a pregnant woman does not have a parent/caretaker basis until the child is born unless he is already a parent to another child in this household.
MinnesotaCare Enrollee Becomes Pregnant
When a MinnesotaCare enrollee reports a pregnancy, take the following steps.
Note: If you become aware of a pregnancy through a health plan, provider, or another MinnesotaCare enrollment site or county agency, contact the enrollee for month of conception and estimated date of delivery before taking these steps.
1. Enter the necessary information on MMIS to change the woman's eligibility to pregnant woman effective the first of the month of conception or the date the woman last became active on MinnesotaCare, whichever is later. MMIS will increase the household size by the number of expected fetuses. Do not include the father of the expected child in the household if he and the mother are not married and have no other children in common in the household.
n Change eligibility to pregnant woman beginning the month of the birth through two months postpartum for enrollees who did not report the pregnancy until after the birth, unless the woman provides verification that includes the month of conception. Do not consider the birth itself to be verification of pregnancy for any previous months.
n Pregnant women who meet specific citizenship or immigration requirements are eligible with federal funding. See MinnesotaCare for pregnant women.
2. Review the woman's eligibility. If she is married, also review her husband’s eligibility. See Effect of Pregnancy on MinnesotaCare Eligibility below.
3. Request verification of the pregnancy. See MinnesotaCare for pregnant women for further information about verification requirements.
4. Any co-payments totaling $30 or more paid by the pregnant woman after the date of conception may be refunded. Instruct women who want a refund of co-payments to request the refund from the provider to whom the co-payment was paid.
Effect of Pregnancy on MinnesotaCare Eligibility
A MinnesotaCare enrollee who becomes pregnant may experience a change in eligibility. Eligibility of other household members, including the pregnant woman's husband, may also be impacted by an enrollee's change to pregnant woman status.
l Change the eligibility of children under 21 who become pregnant.
l Change the eligibility of a non-pregnant adult who becomes pregnant effective the first day of the month of conception.
n She retains that eligibility through the 60-day postpartum period.
n Review her eligibility for the month after the 60-day postpartum period ends and make any necessary changes for the first available month.
Example:
Mary is a single adult without children. She reports she is pregnant and
verifies June was the month of conception. Her income is 135% FPG, and
she is a U.S. citizen.
Action:
Change Mary's eligibility effective June 1. She will retain this eligibility
through the end of her 60-day postpartum period. Effective the month after
her 60-day postpartum period, if the child continues to live with her,
change Mary's eligibility to an adult with children with 10-day notice.
l If the pregnant woman is married, her husband is also considered a parent. Change the husband to an adult with children. His MPET will depend on his citizenship and immigration status and income.
n He retains this eligibility through the month in which the pregnancy ends or they no longer have a child under 21 in the home, whichever is later.
n Review his eligibility for the first available month following the end of the pregnancy with 10-day notice.
l Stop Deeming sponsor income and assets for the household while the woman is pregnant if anyone in the household is a sponsored noncitizen. Stop deeming for the month of conception or back to the first month of coverage, whichever is earlier. Remove any previous sponsor income and recalculate the total annual household income and premium.
Example:
Rosa and her husband, Emilio, are enrolled in MinnesotaCare as adults without
children. Emilio and Rosa are sponsored noncitizens. The sponsor's income
is counted in their total annual household income and the sponsor's assets
are counted in the household's asset total. On April 23, Rosa reports
that she is pregnant. She provides proof from her midwife that her estimated
date of conception is March 10.
Action:
Change Rosa's eligibility to pregnant woman and Emilio's eligibility to
an adult with children effective March 1. Determine eligibility for both
Rosa and Emilio without counting the sponsor income as part of their total
annual household income and without counting the sponsor assets in the
household's asset total. The MCRE household size will change from two
to three. MMIS will adjust the premium accordingly for the next available
month.
For more information, see:
MinnesotaCare Eligibility Groups.
Change in MinnesotaCare Eligibility.
Child Under 21 Becomes Pregnant.