Budgeting Procedures for Pregnant Women 510-03-90-25

(Revised 1/18/2023 ML #3698)

View Archives

 

(N.D.A.C. 75-02-02.1-21)

 

 

The Omnibus Budget Reconciliation Act of 1990 provided for extended eligibility for pregnant women effective July 1, 1991.

 

When a pregnant woman becomes eligible for Medicaid, including during the three month prior period (THMP), she continues to be eligible, without regard to any increase in income of the ACA Medicaid Household, for twelve months after the day her pregnancy ends, and through the last day of the twelfth month. Decreases in income, however, will be considered to further reduce any client share (recipient liability). All other Medicaid eligibility factors continue to apply.

• Self-attestation of a single-birth or multi-fetus pregnancy is accepted unless it is questionable.
• For determinations made after the birth of the baby, the child’s birth verification may be used as verification of pregnancy.

 

When a woman applies for coverage and is pregnant, if eligible, she must be enrolled in Medicaid coverage as a pregnant woman, rather than in the new Adult Expansion Group.

 

When a woman is already enrolled in the Adult Expansion Group, and becomes pregnant after her enrollment, she must be given a choice to move to the pregnant women coverage group.

• If the woman chooses Medicaid coverage as a pregnant woman, during the final month of the twelve-month period of eligibility, a review must be completed to evaluate whether she will remain eligible for Medicaid under another coverage group, or be referred to the Marketplace to chose an insurance policy. This will ensure there is no loss of coverage.

 

For policy relating to Extended Eligibility for Pregnant Women, refer to 510-03-45-05.