|
Effective: December 1, 2006 |
|
|
03.15ar1 - Enrollee Becomes Pregnant (Archive) |
Archived: February 1, 2008 |
Minnesota Health Care Program enrollees who become pregnant will most likely experience a change in eligibility group, basis of eligibility, or major program.
GAMC Enrollee Becomes Pregnant.
MinnesotaCare Enrollee Becomes Pregnant.
Effect of Pregnancy on MinnesotaCare Eligibility Group.
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, follow up with 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.
Women who become pregnant while receiving GAMC become eligible for MA without a new application. Their MA eligibility is effective the first of the month of conception or the GAMC eligibility begin date, whichever is later. See MA for pregnant women for more information on eligibility requirements.
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 status 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.
a. If you first become aware that an enrollee was pregnant after the birth, change her status to "pregnant woman" beginning with the birth month and through two months postpartum, unless you receive verification that includes the month of conception. Do not consider the birth itself to be verification of pregnancy for any previous months.
Note: Pregnant women who are meet specific citizenship or immigration requirements will be eligible with federal funding. See MinnesotaCare for pregnant women.
2. Review the woman's group status. If she is married, review her husband’s group status also. See Effect of Pregnancy on MinnesotaCare Eligibility Group below.
3. Request verification of the pregnancy. See MinnesotaCare for pregnant women for further information about verification requirements.
a. If the household fails to submit verification within 30 days of the initial request for verification, send a notice informing the household that the woman will lose pregnant woman status if verification is not received within 30 days of the second notice. If the woman is married, any pregnancy-related changes to her husband’s group status will also be affected.
Example:
Cindy and her husband Bruce enrolled in MinnesotaCare as Group Three adults without children in May with income of 150% FPG. On August 15, Cindy reports that her pregnancy was confirmed at the doctor's office on August 12. Her estimated date of conception is July 7.
Action:
Change Cindy's status to pregnant woman and assign Cindy to Group Two and Bruce to Group Four effective July 1. Request verification of the pregnancy.
l If Cindy fails to submit verification within 30 days of the request, send a notice informing her that she will lose pregnant woman status and she and Bruce will be reassigned to Group Three unless she submits verification within 30 days.
l If she fails to submit verification within 30 days of the second notice, change their status back to Group Three adults effective the first available month.
4. Any co-payments totaling $30 or more paid by the pregnant woman after the date of conception may be refunded. If a woman wants to be refunded co-payments, instruct her to request the refund from the provider to whom the co-payment was paid.
Effect of Pregnancy on MinnesotaCare Eligibility Group
When a MinnesotaCare enrollee becomes pregnant, she may experience a change in eligibility group. If she is married, her husband may also experience a change in group status, even if there are no other children in the household.
l Children under 21 who become pregnant retain their Group One or Group Two status (unless the increase in household size results in Group One status for a Group Two child).
l Change a Group Three or Group Four woman who becomes pregnant to Group Two status effective the first day of the month of conception.
n She retains Group Two status through the 60-day postpartum period.
n Review her group status 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 enrolled in Group Three. 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 to Group Two status effective June 1; she will retain this status through the end of her 60-day postpartum period. Effective the month after her 60-day postpartum period, change Mary to Group Four status with 10-day notice.
l If the pregnant woman is married, change her husband to either Group Two or Group Four status, depending on citizenship/immigration status and income.
n He retains this status 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 group status for the first available month following the end of the pregnancy with 10-day notice.
For more information, see:
MinnesotaCare Eligibility Groups.
Change in MinnesotaCare Eligibility Group.