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Medical Services-12000 Section

Medical Services Manual

7/01/04

12100     Medicaid Coverage for Pregnant Women                                               

 

There are three basic coverage groups for pregnant women, PW-No Grant, PW-Medically Needy (Exceptional and Spend Down) and SOBRA PW (including Presumptive Eligibility).


 

 

PREGNANT WOMEN CATEGORIES ELIGIBILITY CHART

 

 

   CATEGORY       SERVICES         POSTPARTUM          INCOME         RESOURCES

 

PW No Grant 

 

Full range of Medicaid services

None if application made after birth of child. Through end of month in which 60th day postpartum falls if made while pregnant.

At or below 29% Reduced Standard of Need   (Appendix T)

Not to exceed $1,000 for the unit

PW Medically Needy

Exceptional

Full range of Medicaid services except Nursing Facility and Personal Care Services

 

None if application made after birth. Through end of month in which 60th day postpartum falls if made while pregnant.

MNIL for unit size 

(MS 7610)

MNRL for unit size 

(MS 7500)

PW Medically Needy

Spend-Down 

 

Full range of Medicaid benefits for   Spend-down period except Nursing Facility and Personal Care Services

None if application made after birth. Through end of month in which 60th day postpartum falls if made while pregnant.

Above SOBRA income limit for   unit size

(Appendix F)

MNRL for unit size

(MS 7500)

SOBRA PW

 

Services related to pregnancy, delivery & postpartum only

Through end of month in which the 60th day postpartum falls

200% FPL

for unit size (Appendix F)

MNRL for

unit size

(MS 7500)

SOBRA Presumptive Eligibility (PE)

Ambulatory prenatal care only

None

200% FPL

for unit size

(Appendix F)

 Not Applicable