2720 Continuous Coverage For Pregnant Women

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Continuous Coverage For Pregnant Women

Effective Date:

December 2022

Chapter:

2700

Policy Number:

2720

Previous Policy Number(s):

MT 65

Updated or Reviewed in MT:

MT-68

Requirements

A pregnant woman, adult or minor, who becomes or would otherwise become ineligible for any Medicaid Class of Assistance (COA) because of a change of an Assistance Unit (AU) or Budget Group (BG) member remains eligible for Medicaid for the remainder of her pregnancy and through the 12- month extended postpartum period.

See Section 2184 Pregnant Women for the eligibility criteria for the 12-month extended postpartum period.

Basic Considerations

Continuous coverage for a pregnant woman applies in the following situations:

  • a pregnant woman who becomes ineligible for SSI because of an increase in income or resources

  • a pregnant woman who becomes ineligible for any Medicaid COA because of a change such as an increase in net taxable income, sanctioned for failing to cooperate with DCSS, etc.

For Women’s Health Medicaid if she becomes pregnant and is eligible for Pregnant Woman Medicaid, a CMD to Pregnant Woman Medicaid must be completed. After her continuous coverage period expires, complete a CMD to Parent/Caretaker with Child(ren) Medicaid. If ineligible for Parent/Caretaker with Child(ren), CMD back to WHM if she is still eligible. Her child(ren) will be a deemed newborn(s). If a PeachCare for Kids_®_ enrollee becomes pregnant, a CMD to Pregnant Woman Medicaid must be completed.

For continuous coverage purposes, an increase in net taxable income includes any one of the following:

  • an increase in the AU’s or BG’s taxable income

  • a decrease or loss of MAGI deductions

  • a decrease in the number of individuals included in the AU and/or BG per stated tax status

  • the addition to the AU and/or BG of an individual with taxable income per stated tax status

  • expiration of the MN budget period if the pregnant woman was Medicaid eligible or would have been if her pregnancy was known

  • any other change that results in excess net taxable income.

Continuous coverage for a pregnant woman includes reinstatement of Medicaid if a voluntary closure or other termination has occurred, whether or not the pregnancy was known at the time of termination.

A pregnant woman who is approved for EMA is not automatically eligible for the 12- month extended postpartum period. She may, however, qualify for additional days of EMA during the 12-month extended postpartum period if she receives pregnancy-related emergency treatment. Refer to Section 2184, Pregnant Women.

Procedures

Use the following procedures to establish continuous coverage eligibility for a pregnant woman:

Step 1

Determine that the pregnant woman would otherwise be ineligible to continue Medicaid under the current COA because of an increase in AU/BG net taxable income or other change.

or

Determine that a pregnant woman is ineligible for SSI because of an increase in income or resources. The following sources may be used to verify SSI ineligibility:

  • SSI notification letter

  • State Data Exchange (SDX)

  • other verification from the Social Security Administration

  • GAMMIS

    Step 2

    Establish that the woman was pregnant during the last month of Medicaid eligibility and that her pregnancy has terminated.

    Step 3

    Determine that the pregnant woman met non-financial eligibility requirements during the last month of eligibility for the COA under which Medicaid is being or would be terminated.

    Step 4

    Continue Pregnant Woman coverage or approve Pregnant Woman if the pregnant woman is/was not actively receiving Medicaid under another COA.

Special Considerations

A pregnant woman who is correctly determined Medicaid eligible remains financially eligible from the effective month of approval through the end of the 12-month extended postpartum period, regardless of changes in the BG income.

Pregnant individuals (including Individuals in their postpartum period) can be terminated for the following reasons:

  • Voluntary termination

  • Moves out of state

  • Invalidly enrolled

  • Death

    Gaining SSI is not an allowable reason for termination during the 12-month extended postpartum period.

If a pregnant individual is actively enrolled in PeachCare for Kids_®_ at delivery/termination of pregnancy, the individual must remain eligible in PeachCare for Kids_®_ through the last day of the month in which the 12-month extended postpartum period ends regardless of any changes in circumstances that may affect eligibility (aging out, income, household composition, non-payment of premium or becoming Medicaid/SSI eligible).