Coverage is available to pregnant women, and women who are within the first 3 months (backdate months) of their postpartum period, who are determined ineligible for all Cash, FamilyCare and All Kids Assist programs through case progression. This includes pregnant women ineligible for FamilyCare Assist and All Kids Assist due to failure to meet citizenship/INS status (see PM 03-01-02 and PM 06-05-01).
Woman is No Longer Pregnant at Application
Medical benefits are available to a woman of any age whose pregnancy has ended, but who would have qualified had the pregnancy continued.
A woman whose pregnancy has ended qualifies for Moms and Babies or Family Health Spenddown if the pregnancy ended in:
- the month of application; or
- one of the 3 months prior to the month of application.
Medical benefits cannot be approved for any time earlier than 3 months before the month of application.
A baby is automatically eligible for Moms & Babies as a deemed newborn when the mother was eligible for medical coverage at the time of the baby's birth under any of the following medical programs: Moms & Babies, FamilyCare, All Kids Assist, AABD, ACA Adult and Former Foster Care.
The mother can be approved for medical coverage before the baby is born or could be approved retroactively in a backdate request for medical. The newborn is automatically eligible regardless of whether the mother's coverage was approved before or after the baby's birth or whether the Department was aware that the mother was pregnant.
When the newborn is determined to be automatically eligible due to mother's eligibility for medical, a SSN or signed request for the baby is not required until age 1. Add the baby as soon as the baby's birth is reported.
Mother Eligible for Family Health Spenddown
A baby born to a pregnant woman who is receiving Family Health Spenddown (met or unmet) at the time of the baby's birth is not automatically eligible. Obtain a signed request for the baby (on the application or a form 243A Request to Add an Additional Household Member) and a SSN or proof of application for a SSN.