5160:1-1-64 MAGI-based medicaid: coverage for pregnant women.

 

 

 

TO BE RESCINDED

 

5160:1-1-64                 MAGI-based medicaid: coverage for pregnant women.

 

 

 

(A)   This rule describes eligibilty for pregnant women as described in 42 C.F.R. 435.116 (as in effect on April 1, 2013) for applications for medical assistance filed on or after January 1, 2014.

 

(B)  Eligibility criteria for coverage because a woman is pregnant.

 

(1)   The individual must be female and pregnant. Unless the administrative agency has information contradicting an individual's statement, the individual's statement is sufficient verification of her pregnancy.

 

(2)   The woman's household income must not exceed two hundred per cent of the federal poverty level for the family size.

 

(C)  Eligibility span for pregnant women.

 

(1)    Once established, eligibility for a pregnant woman continues throughout her pregnancy and postpartum period.

 

(2)   A woman is eligible for postpartum coverage if she was eligible for medicaid on the date her pregnancy ends. This includes a birth mother whose labor and delivery services were furnished prior to the date of application and who is determined eligible for retroactive coverage of the labor and delivery services as described in rule 5101:1-37-51 of the Administrative Code.

 

(D)  Administrative agency responsibilities. The administrative agency must:

 

(1)   Calculate a pregnant woman's family size and household income as described in rule 5101:1-37-61 of the Administrative Code.

 

(2)   Inform a pregnant woman who has indicated that she is carrying more than one fetus whether medical verification of her pregnancy might, by increasing her family size, cause her to be income-eligible for medicaid.

 

(3)     Not terminate eligibility for a pregnant woman during her pregnancy or postpartum period unless the woman dies, moves out of state, or requests that coverage be terminated.

 

(E)     Individual  responsibilities.  The  individual  must  provide  medical  verification  of

 

 

 

pregnancy, only if necessary for income eligibility by increasing the family size.

Effective:                                                             01/01/2016

Five Year Review (FYR) Dates:                         10/16/2015

CERTIFIED ELECTRONICALLY

Certification

12/21/2015

Date

Promulgated Under:                           111.15

Statutory Authority:                           5162.03, 5163.02

Rule Amplifies:                                  5162.03, 5163.02, 5163.40

Prior Effective Dates:                         10/1/13