WAG 06-09-05: Eligibility for Moms & Babies

PM 06-09-05

  1. revised text(FCRC/All Kids Unit) Enter due date and the number of births expected on the Pregnancy-Details screen in IES. Enter the information that the client provides; proof of pregnancy and proof of the number of expected births is not required.
  2. revised text(FCRC/All Kids Unit) Allow up to 7 months after the application date for the delivery date if the client did not give a date.
  3. revised text(FCRC/All Kids Unit) Enter the end date in the Pregnancy-Details screen when pregnancy ends due to a birth, miscarriage or abortion. 
  4. revised text(IES) Reruns eligibility for the month following the end of the 60 day post partum period if the pregnancy ends prior to the end of the certification period. See PM 19-02-07 for information about certification periods for pregnant women and newborns. See WAG 19-08-00 for information about batch actions in IES.

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 & 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 & 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 & Babies Income Standard for 07/02 but less than the Moms and Babies Income Standard for 08/02. Approve Moms & 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 & 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 & Babies for 12/02, but is income eligible for 01/03. Approve Moms & 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 & 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 & 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 & Babies in April. Approve Moms & 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 & 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 & 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 & Babies starting 01/03 and Family Health Spenddown for September through December.