PM 06-09-05

  1. (FCRC) Ask the client at the eligibility interview for an expected delivery date when the medical verification does not have a delivery date.
  2. (FCRC) Use the date the client gives.
  3. (FCRC) Allow up to 7 months after the application date for the delivery date if the client cannot give a date.
  4. (FCRC/All Kids Unit) Enter EDD, Expected Delivery Date, in Item 60 of the Form 552 so the case is selected for the Priority Action List (PAL) as code P, Pregnant Woman Due. The EDD must be used when:
    • approving, using TA 10, TA 11, or TA 12;
    • adding to an existing case, using TA 34; or
    • changing a pregnant woman's status to Moms & Babies, using TA 31.
  5. (System) Puts the case on the PAL for the month following the Expected Date of Delivery (EDD). The case will show every other month as long as code P stays in Item 78 of the Form 552.

When the pregnant woman is not asking for medical backdating:

  1. (FCRC/All Kids Unit) Consider income for the application month. Countable income cannot be more than the Moms and Babies income standard for that month.
  2. (FCRC/All Kids Unit) Consider income for the month following the application month through the current processing month if the woman is income ineligible for the application month.
  3. (FCRC/All Kids Unit) Approve Moms and Babies starting with the application month or the following month, if the woman meets income requirements for that month.

    Example: A pregnant woman applies for medical on 07/31/02. She does not want medical backdating. Income is greater than the Moms and Babies Income Standard for 07/02 but less than the Moms and Babies Income Standard for 08/02. Approve Moms and Babies starting 08/01/02. 

  4. (FCRC/All Kids Unit) Do not consider income changes that happen after the approval month through the 60-day postpartum period.
  5. (FCRC/All Kids Unit) Approve the application month as Family Health Spenddown for a client approved for Moms and Babies for the month after the application month.

Example: A pregnant woman applies for benefits 12/03/02. The applicant is income ineligible for Moms and Babies for 12/02, but is income eligible for 01/03. Approve Moms and Babies starting 01/01/03. Family Health Spenddown for 12/02.

When the pregnant woman asks for medical backdating:

Countable income cannot be more than the Moms and Babies Standard for the earliest backdated month eligibility is being authorized.

  1. (FCRC/All Kids Unit) Consider income for the previous months in the following order:
    • for the earliest backdated month, up to 3 months, before the application month;
    • for the other 2 months if the woman is income ineligible for the earliest month;
    • for the application month if the woman is income ineligible for all the backdate months;
    • for the month(s) after the application month through the current processing month if the woman is income ineligible for all the backdate months and the application month.
  2. (FCRC/All Kids Unit) Approve Moms and Babies starting with the earliest month, up to 3 months before the application month, the client meets requirements.
  3. (FCRC/All Kids Unit) Do not consider income changes that happen after the approval month through the 60-day postpartum period.
  4. (FCRC/All Kids Unit) Approve the application month and any backdated months for any months countable income exceeds the standard, as Family Health Spenddown.

Example 1: A pregnant woman applies for benefits on 07/02 and asks for medical backdating for April, May, and June. She is eligible for Moms and Babies in April. Approve Moms and Babies starting 04/01.

Example 2: A pregnant woman applies for benefits on 12/04/02 and asks for medical backdating for September, October, and November. She is income ineligible for September but income eligible for October. Approve Moms and Babies starting 10/02 and Family Health Spenddown for September.

Example 3: A pregnant woman applies for benefits on 12/05/02 and asks for medical backdating for September, October, and November. She is income ineligible for the backdate months but is income eligible for December. Approve Moms and Babies starting 12/02 and Family Health Spenddown for September through November.

Example 4: A pregnant woman applies for benefits on 12/05/02 and asks for medical backdating for September, October, and November. She is income ineligible for the backdate months and the application month but is income eligible for January. Approve Moms and Babies starting 01/03 and Family Health Spenddown for September through December.