5320           PREGNANT WOMAN POSTPARTUM ELIGIBILITY

A pregnant woman who applied for and was receiving Medicaid or Denali KidCare coverage on or before the date of termination of the pregnancy (either by delivery, miscarriage, or Medicaid funded abortion) will automatically receive 60 days of postpartum coverage.  Coverage begins on the day the pregnancy ends through the last day of the month in which the 60 days end.

Termination of the pregnancy must be verified in order to calculate the postpartum eligibility.  The date of pregnancy termination and name of the child may be verified by a statement (written or oral) from the mother, hospital records, birth certificate, or any other contact the caseworker determines to be a reasonable verification.

Postpartum eligibility may not be granted retroactively.  However, if the woman applies for Medicaid or Denali KidCare before the date of termination of the pregnancy and is subsequently found eligible for either coverage (even if the eligibility determination is not made until after the date of pregnancy termination), the woman can be considered to be receiving Medicaid or Denali KidCare for purposes of postpartum eligibility since her Medicaid or Denali KidCare is effective back to the 1st day of the application month.

The only conditions of eligibility for postpartum coverage are Alaska residency and cooperation with establishment of TPL Third Party Liability .  Cooperation with CSSD Child Support Services Division is not required during the postpartum period.

If an APA Adult Public Assistance recipient loses eligibility for cash benefits during the postpartum period, her Medicaid eligibility continues under postpartum coverage throughout her 60-day postpartum period.

Because of the one day-one month Medicaid and Denali KidCare principle, the woman may receive more than 60 days of coverage as coverage extends through the last day of the month in which her 60-day period ends.

Example:  

The household consists of a woman and her newborn child. The woman was receiving Denali KidCare coverage on the date of delivery, which was June 5th.  The woman is guaranteed Medicaid or Denali KidCare coverage until the 4th of August (60 days of postpartum coverage).  However, because of the one day-one month principle, the woman remains eligible through August 31st.  The coverage continues regardless of the woman's circumstances.

The Medicaid eligibility code remains 11 through the end of the postpartum period.  If the woman receives Medicaid under an eligibility category not based on pregnancy, such as FM Family Medicaid or APA Adult Public Assistance , her eligibility code should be returned to the proper one for the eligibility category she fits (e.g., 20, 50, etc.) effective the first day of the month after postpartum coverage ends.

Note:  

If a woman receiving Family Medicaid or APA Adult Public Assistance eligibility category loses eligibility during her 60-day postpartum period, she should be put on an ME AF case and coded PB or PC and 11.