Title 16
16000 Federal Poverty Level Related Programs
16270 Continuous Eligibility of Pregnant Women
Once a pregnant woman is determined eligible, she remains eligible throughout pregnancy and the post partum period regardless of changes in family income.
16270.1 Post Partum Period
The post partum period is a mandatory extension of benefits for women who were determined eligible for Medicaid in the month of birth or in a month prior to the month of birth (while still pregnant). A woman cannot apply and be found eligible for the post partum period alone. The post partum period is an extension of Medicaid coverage that was provided because of pregnancy. Illegally residing aliens are not eligible for the post partum extension.
In most cases, a pregnant woman must apply in the month of birth or in a month prior to the month of birth (while still pregnant) in order to have Medicaid coverage for the delivery and post partum period. This is because most pregnant women are required to enroll in managed care and are not eligible for retroactive Medicaid coverage. A woman who is excluded from managed care and therefore potentially eligible for retroactive coverage, could apply up to 3 months after the month of birth and be found eligible for the delivery and post partum period.
If a pregnancy is terminated through miscarriage or a federally funded abortion, the woman is still entitled to the post-partum period. If a mother delivers a child who dies a few days after birth, she is still entitled to the post-partum period. The deceased child must be added to the case through DCIS to cover any bills he may have incurred between birth and death.
If a pregnant woman plans to put her baby up for adoption, she will receive the regular post-partum period. The baby will also be eligible through the mother's post-partum period. The baby may then be eligible for Medicaid under the Adoption Assistance Program. The adoption agency should apply for Medicaid for the infant while the child is awaiting an adoptive home.
The post-partum period is increased from 60 to 90 days as part of the demonstration waiver under the Diamond State Health Plan. Effective 10/1/95 the post partum period extends 90 days beginning on the last day of pregnancy. Any woman whose post partum period ends 9/30/95 or later will have the post partum period extended. This means that any woman who delivers on 8/1/95 or later will get 90 days post partum.
Medicaid eligibility related to the post partum extension ends on the last day of the month in which the 90 day period ends.
