PM 06-09-06
When a woman in an active medical case reports a pregnancy, enter the following information on the Pregnancy Details page:
- Pregnancy Due Date;
- Number of births expected; and
- Pregnancy End Date (when reported).
Certify the change. This action ensures that, if eligible, the woman receives continuous eligibility for medical benefits through her postpartum period.
Note: Pregnancy ends at birth, miscarriage or abortion.
Backdating
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.
- 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.
Approve the application month and any backdated months for any months countable income exceeds the standard, as Family Health Spenddown.
Backdating Examples
Example 1: A pregnant woman applies for benefits on 07/05/2022 and asks for medical backdating for April, May, and June. She is eligible for Moms & Babies in April. Approve Moms & Babies starting 04/01/2022.
Example 2: A pregnant woman applies for benefits on 12/04/2022 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 10/01/2022 and Family Health Spenddown for September.
Example 3: A pregnant woman applies for benefits on 12/05/2022 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 12/01\2022 and Family Health Spenddown for September through November.
Example 4: A pregnant woman applies for benefits on 12/05/2022 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 01/01/2023 and Family Health Spenddown for September through December.
