5310            PREGNANT WOMAN ELIGIBILITY

5310 A.       GENERAL ELIGIBILITY CRITERIA

A pregnant woman whose household income does not exceed 175% of the Federal Poverty Guideline for Alaska for her household size, who meets the Family Medicaid non-financial criteria, and whose pregnancy has been medically verified is eligible for Denali KidCare.  There is no resource requirement or insurance restriction for this coverage.  See Addendum – 1.

To determine income eligibility, take into consideration the needs and income of all household members who must be included in a Family Medicaid household.  These include:

• The spouse of the pregnant woman;
   

• Her children;
   

• The parents of the Under 21 pregnant woman; and,
   

• The needs of the unborn (or unborns if multiple births have been verified) must be included as though the child were born.

Note:  

The needs and income of the father of the unborn child are not included in this determination unless he is the spouse of the pregnant woman.

Countable income is determined by following Family Medicaid rules except for income or disregards that are prohibited from being counted under Section 5020.  A pregnant woman is eligible if the countable income of the household (including the unborn) does not exceed the income eligibility standards for her household size.

Once determined eligible, a pregnant woman is covered throughout her pregnancy, including the 60-day postpartum period, without regard to changes in her household income.  Thus, the woman will remain eligible during her pregnancy and postpartum period even if her income later exceeds the income standard.  See Addendum - 1.  However, she must remain an Alaska resident and notify the agency at the end of her pregnancy.  A pregnant woman is not required to cooperate with CSSD in establishing paternity or pursuing medical support orders until after her postpartum period ends.  See Section 5320.

Example 1:

The household consists of a pregnant mother, her husband, and their two children.  To determine eligibility, the caseworker would consider the needs and income of the mother, father, the unborn, and the two children.  If the household's countable income as determined by Family Medicaid rules does not exceed the poverty level standard for a 5 person household, the mother is eligible for Denali KidCare as a pregnant woman.  The children, if age 18 or under, may also be eligible for Denali KidCare using a 4-person household size as the needs of an unborn child are included only in determining eligibility for the pregnant woman.

Example 2:

The household consists of a mother and her pregnant 17-year-old daughter.  To determine eligibility, consider the needs and income of the adult mother, her daughter, and the unborn child.  Since Denali KidCare considers parental responsibility to continue until a child is 21, the adult mother's income is considered available to her minor daughter.  If the pregnant minor’s income and the income of the adult mother, after allowable deductions, do not exceed the income standard for a household size of 3, the daughter is eligible for Denali KidCare as a pregnant woman.

Example 3:

The household consists of a pregnant woman, a child, and the father of the children, both born and unborn, who is not married to the pregnant woman.  To determine eligibility, consider the needs of the pregnant woman and her children, including the unborn, and the income of the pregnant woman only.  The needs and income of the children's father are not included because he is not the spouse of the pregnant woman.  However, any income he contributes directly to the pregnant woman must be considered as income to her.  If the mother's countable income does not exceed the standard for a household size of 3, the woman is eligible for Denali KidCare as a pregnant woman.  The child, if age 18 or under, may have his or her eligibility determined; the household size is 3 and the father's income would count in that determination since a parent's income is considered available to a born child.

5310 B.       RETROACTIVE ELIGIBILITY FOR PREGNANT WOMEN

Pregnant Woman eligibility may extend three months retroactively if the applicant was pregnant during that period and meets all other Denali KidCare eligibility requirements.  Even if a woman is not eligible in the application month or month following the application month, but is eligible in Alaska in one of the three retroactive months before the application month, she is considered eligible for Denali KidCare from that month throughout her pregnancy, regardless of changes in her household income.

Example:

Aina applies for Pregnant Woman Medicaid in September and requested Retroactive Medicaid for the month of July.  The caseworker determines that Aina is eligible for Retroactive Medicaid in July.  The caseworker does not make any further eligibility determinations.  Aina is eligible for Pregnant Woman Medicaid beginning July and eligibility continues from that month forward through the month of her estimated due date.  

5310 C.       CONTINUATION OF ASSISTANCE FROM OTHER TYPES OF MEDICAID

A pregnant woman eligible under any Medicaid eligibility category who loses eligibility for that Medicaid category because of a change in her household's income or due to a requirement that is not a criterion of Denali KidCare may remain eligible for health care coverage under Denali KidCare throughout her pregnancy and postpartum period.

Example:  

A pregnant woman's Family Medicaid case is closed due to excess unearned income.  Although ineligible for Family Medicaid, she continues to receive health care coverage under Denali KidCare.

On EIS Eligibility Information System, the “thru month” should be the expected last month of the woman's pregnancy.

A pregnant woman is issued a Medicaid Recipient Identification Card (coupon) with peel off labels, not the Denali KidCare card.