Women receiving Moms and Babies coverage are redetermined at the end of the postpartum period. Eligibility factors are reviewed to determine if the individual is eligible for the Form A or Form B process.
IES reviews the Pregnancy End Date field on the Pregnancy Details Screen to see if a date has been entered. If the Pregnancy End Date field is populated, then the normal Form A/B Determination process continues. If the Pregnancy End Date is not entered, the customer receives Form B.
If the Form B is not returned in time, the Pregnancy End Date is set to the Pregnancy Due Date. The postpartum period is not approved in this scenario and the following case comment is entered: Per JIRA ILIES-259643, customer did not provide Pregnancy End Date. Pregnancy End Date field populated with the Estimated Delivery Date (EDD)."
If Form B was returned and does not provide the pregnancy end date, an extension of up to 2 months may be added to the certification period to allow closure of Moms and Babies coverage and to provide the correct correspondence. Postpartum is not approved in this scenario. The following case comment will be entered: "Per JIRA ILIES-259643, customer did not provide pregnancy end date. Pregnancy End Date field populated with the Estimated Delivery Date (EDD)."
Note: IES may add the extension when the reported Expected Date of Delivery (EDD) is in the past and the pregnancy end date field is not populated (See WAG 06-09-07).
Note: Updating the postpartum period to 12 months might cause misaligned certification periods. These EDGs are reviewed for alignment at the earliest opportunity.
For all newborns, eligibility must be redetermined when the newborn reaches age one year. Client cooperation for the redetermination is required.