pregnancy medical
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pregnancy medical


Revised June 20, 2014



Pregnancy Categorically Needy Medical (P02) and Non-Citizen Pregnancy Medical (P04)

 

Family Planning Service Only (P05)

 

Pregnancy Categorically Needy Medical (P99)

 


PREGNANCY CATEGORICALLY NEEDY MEDICAL (P02) AND Non-Citizen pregnancy medical (p04)

NOTE: As a result of implementation of the Affordable Care Act (ACA), effective with applications received on or after 10/01/2013 this medical program is no longer valid. Any current active AUs with this medical coverage type will continue through the AUs current certification period. Clients would then need to apply for medical through the healthplanfinder.

 

Who is eligible to receive P02 medical?

 

Who is eligible to receive P04 medical?

 

How long is the P02/P04 certification period?

 

When is a pregnant woman not eligible for the post partum Medical Extension?

 

How do I screen a P02/P04 AU?

 

How do I process a pending P02/P04 AU?

 

What if the pregnancy ends before the original due date?

 

What if the pregnancy ends after the original due date or during the post partum extension?


Who is eligible to receive P02 medical?

 

·         A pregnant woman who meets the criteria in the following WAC may be eligible for P02 Medical: WAC 182-505-0115 Washington Apple Health - Eligibility for pregnant women.

 

Who is eligible to receive P04 medical?

 

·         A pregnant woman who is not eligible for CN medical due to: Citizenship or alien status. See  WAC 182-505-0115 Washington Apple Health - Eligibility for pregnant women.

 

How long is the P02/P04 certification period?

 

·         P02/P04 medical is certified until the last day of the month in which the 60th day after the pregnancy ends as long as the mother received Medicaid at the time of the baby's birth.

 

·         At the end of the P02/P04 certification period, ACES automatically trickles to a ten or twelve month Family Planning Medical (P05) certification period.

 

·        See  WAC 182-504-0015 Washington Apple Health - Certification periods for categorically needy (CN) programs.


NOTE:

Pregnancy medical has continuous eligibility. Changes in income do not affect P02 or P04 medical during the certification period.


When is a pregnant woman not eligible for the post partum Medical Extension?

 

·         If the application is not made and eligibility is not determined prior to when the pregnancy ends, a pregnant woman is not eligible for the two-month post partum medical extension, even if medical care is authorized retroactively to cover the pregnancy.

 

·         A client can apply for medical assistance to cover the expense of the birth of the baby even after the baby is born.

 

·         When a woman is not eligible for the post partum extension, Family Planning (P05) coverage begins the first of the month following the month the pregnancy ended.

 

How do I screen a P02/P04 AU?

 

·         To screen a P02/P04 AU, take the following steps:

 

1.      From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

 

2.      On the Applicant page enter the head of household’s Name, Residential and Mailing Addresses.

 

3.      On the Programs page,

 

o       Click the checkbox next to Medical, and

 

o       Click the Next button.

 

4.      Continue the screening process until you reach the Finalize page.

 

5.      If the Programs section does not list the P02 or P04 Coverage Group, click the Specify Program button. The Finalize – Program Details page displays.

 

6.      On the Finalize – Program Details page, select Medical Assistance (MA) from the Program drop-down box, and

 

o       Select Categorically Needy Pregnancy (P02) or Non-Citizen Pregnancy (P04) from the Medical Coverage Group drop-down box, and

 

o       Click the Next button.

 

o       See Screening – aces.online, Screening a Client for additional information on completing screening.

 

7.      On the Finalize page:

 

o       Click the checkbox next to the P02 or P04 program.

 

o       Enter the application date.

 

o       Click the Commit button to commit the screening data.


NOTE:

A pending P02 AU will trickle to P04 when the client does not meet P02 citizenship or alien status criteria.


How do I process a pending P02/P04 AU?

 

·         To process a pending P02/P04 AU take the following steps:

 

1.      On the AMEN, select Option O – Interview.

 

2.      On the STAT screen, complete the Finl Resp field as follows:

 

o           [ PN]Applicant for the pregnant woman

 

o           [ SP]Ineligible Spouse for the spouse of the applicant

 

o           [ NM]Not Related and Not Financially Responsible to the Applicant for the unmarried father of the unborn

 

o           [ SC]Child of SSI Related Parents/Child used to determine household size for dependent children living in the home.


NOTE:

For pregnancy medical assistance units, the pregnant woman must be coded as the head of household [SE] on the STAT screen.


3.   On the DEM1 screen, enter pregnancy information in the Due Date and Num Expect fields.

 

4.      Complete the interview following instructions in the Interview chapter.

 

5.      After committing the interview data, follow instructions in the Process Application Month chapter for all pending months.

 

6.      When all pending months have been processed, follow instructions in the Finalize Application  chapter to complete the P02 application process.

 

What if the pregnancy ends before the original due date?

 

·         When the pregnancy ends in a month prior to the original due date entered on the DEM1, take the following steps:

 

1.      On the AMEN, select Option R - Interim/Hist Change.

 

2.      Enter the [Client ID] for the head of the household in the Client ID field.

 

3.      <TRANSMIT> and the ADDR screen displays.

 

4.      On the DEM1, change the pregnancy information to reflect the actual date the pregnancy ended.

 

5.      <TRANSMIT> and an edit message displays at the bottom of the screen stating that the date cannot be entered that is in the past.

 

6.      Press <F4> to continue.

 

7.      Finalize and confirm the information. ACES automatically adjusts the review end date to include the correct post partum extension.

 

What if the pregnancy ends after the original due date or during the post partum extension?

 

·         When the pregnancy ends in a month after the original due date entered on the DEM1, take the following steps:

 

1.      On the AMEN, select Option N – Initiate Review.

 

2.      Enter the [Client ID] for the head of the household in the Client ID field.

 

3.      <TRANSMIT> and the REVI screen displays.

 

4.      On the REVI screen, enter a [Y] in the field next to the P02 AU and <TRANSMIT>.

 

5.      Select Option R – Interim/Hist Change for the ongoing month.

 

6.      Change the pregnancy information on the DEM1 to the new date, and re-enter the verification code.

 

7.      Finalize and confirm the information. ACES automatically adjusts the review end date to include the correct post partum extension.


FAMILY PLANNING SERVICE ONLY (P05)

What is the P05 medical program?

 

How long is the P05 certification period?

 

When will Family Planning Services (P05) begin?

 

What if the client reports a new pregnancy during the Family Planning Extension?

 


 

What is the P05 medical program?

 

·         P05 medical provides coverage for Family Planning medical services for a woman who was eligible for medical coverage on the last day of her pregnancy, or who was approved retroactive pregnancy medical.

 

·        See WAC 388-182-505-0115 Washington Apple Health - Eligibility for pregnant women.

 

How long is the P05 certification period?

 

·         10 months when the client has received post partum coverage.

 

·         12 months from the end of the pregnancy even when eligibility for pregnancy was determined after the pregnancy ended.

 

·        See  WAC 182-505-0115 Washington Apple Health - Eligibility for pregnant women.

 

When will Family Planning Services (P05) begin?

 

·         Medical coverage groups P02, P04, and P99 trickle to the P05 Family Planning Extension coverage group at the end of their regular certification periods.

 

·         If a TANF pregnancy (AF/P/F01) AU closes at end of the post partum period because a newborn has not been added to the AU, it will sprout a P05 AU.

 

What if the client reports a new pregnancy during the Family Planning Extension?

 

·         Close the P05 AU and screen a new P02/P04 medical AU for the new pregnancy.  See How do I screen a P02/P04 AU?


PREGNANCY CATEGORICALLY NEEDY MEDICAL (P99)

Who processes P99 AUs?

 

Who is eligible to receive P99 medical?

 

How long is the P99 certification period?

 

How do I screen P99 medical? -Prior to 10/1/2013

 

How do I process a pending P99 medical?- Prior to 10/01/2013

 

How do I authorize spenddown for a P99 AU in M status?

 

How do I enter medical expenses for a P99 AU in M status?

 

What if the pregnancy ends before the original due date?

 

What if the pregnancy ends prior to the original due date or prior to the certification end date?

 

What if the pregnancy ends after the original due date or during the postpartum extension?

 

When is a pregnant woman not eligible for the Postpartum Medical Extension?

 

When do Family Planning Services (P05) begin?


Who processes P99 AUs?

 

·        Effective 10/1/2013 all P99 AUs are processed by Health Care Authority (HCA) users and are assigned to Region 9 in one of the following MAGI CSO’s:

 

o   181- Houses MAGI AUs that belong to Region 1 geographical/zip catchment

o   182- Houses MAGI AUs that belong to Region 2 geographical/zip catchment

o   183- Houses MAGI AUs that belong to Region 3 geographical/zip catchment

 

·        HCA users have the ability to screen in or reinstate P99 AUs if needed. Users will no longer need to screen in a P02 AU and have it trickle to a P99. P99 will be an available option in screening.

 

1.     HCA users screen in a pending P99 AU that is processed through Interview and Process Application Months.

 

2.      A P99 AU will be in  M – Pending Spenddown status during Option Q – Finalize Application.

 

Who is eligible to receive P99 medical?

 

·         A pregnant woman who meets the criteria in the following WAC may be eligible for P99 Medical:  WAC 182-505-0115 Washington Apple Health - Eligibility for pregnant women.

 

How long is the P99 certification period?

 

·         P99 medical is certified to the end of the final month of the base period as described in WAC 182-519-0110 Spenddown of excess income for the medically needy program.

 

·         The base period should be through the end of the month in which the baby is due but not to exceed 6 months. See EAZ Manual – WAC 182-505-0115 Washington Apple Health - Eligibility for pregnant women – Worker Responsibilities.

 

·         See  WAC 182-504-0020 Certification periods for the noninstitutional medically needy (MN) program.

 

How do I screen P99 medical?

 

Process Prior to 10/01/2013

 

·         A P99 AU is initially screened into ACES as a P02/P04 AU, following the instructions in How do I screen a P02/P04 AU?

 

·         A P02/P04 AU will trickle to P99 during Finalize, if appropriate, when the AU’s countable income exceeds the medically needy income level (MNIL).

 

How do I process a pending P99 medical?

 

Process Prior to 10/01/2013

 

·         While pending, the AU is P02/P04 and is processed following the steps in How do I process a pending P02/P04 AU?

 

·         The P02/P04 will trickle to P99 in M – MA Spenddown status during Finalize when the AU’s countable income exceeds the medically needy income level (MNIL) and has countable resources that do not exceed the standard in  WAC 182-519-0050 Monthly income and countable resource standards for medically needy (MN).

 

·        See EAZ Manual – Medical Assistance – Spenddown for additional information on the spenddown process.

 

How do I enter spenddown medical expenses for a P99 AU in M status?

 

·         To enter medical expenses to meet the client’s Spenddown liability on a P99 AU in M status, see Spenddown - How do I enter medical expenses?

 

·        After expenses have been added, follow the steps in Spenddown - How do I assign medical expenses and authorize spenddown?

What if the pregnancy ends before the original due date?

 

·         When the pregnancy ends in a month prior to the original due date entered on the DEM1, take the following steps:

 

1.      From the AMEN screen, enter Option R - Interim/Hist Change in the Selection field.

 

2.      Enter the Client ID for the head of the household in the Client ID field.

 

3.      <TRANSMIT> and the ADDR screen displays.

 

4.      On the DEM1 screen, change the pregnancy information to reflect the actual date the pregnancy ended.

 

5.      <TRANSMIT> and Edit 1512 – SINCE CLIENT IS PREGNANT, YOU SHOULD DO A FIRST STEPS REFERRAL message displays at the bottom of the screen.

 

6.      Press <F4> to continue.

 

7.      Finalize and confirm the information.

 

What if the pregnancy ends prior to the original due date or prior to the certification end date?

 

·         If the spenddown is met prior to the birth of the baby and the baby is born early, the P99 AU certification period cannot be shortened.

 

·         Check the certification period, and if the certification period will end after the two months post partum period, screen a new P02/P04 AU with the correct due date.

 

What if the pregnancy ends after the original due date or during the post partum extension?

 

·         When the pregnancy ends in a month after the original due date entered on the DEM1, take the following steps:

 

·         A P99 in M - MA Spenddown status – will not allow you to initiate a review.

 

·         If the P99 is in A – Active status, it gives you Edit 1003 SPENDDOWN PERIOD EXPIRES IN A FUTURE MONTH.

 

·         Close the current AU with a 500 level reason code.

 

·         A new P02 AU will need to be screened in with the correct due date.                                                 

 

When is a pregnant woman not eligible for the post partum Medical Extension?

 

·         If application is not made and eligibility determined prior to when the pregnancy ends, a pregnant woman is not eligible for the two-month post partum medical extension, even if medical care is authorized retroactively to cover the pregnancy.

 

·         A client can apply for medical assistance to cover the expense of the birth of the baby even after the baby is born.

 

·         When a woman is not eligible for the post partum extension, Family Planning (P05) coverage begins the first of the month following the month the pregnancy ended.

 

When do Family Planning Services (P05) begin?

 

·         Medical coverage P99 does not sprout a P05 Family Planning Extension AU.  If the woman does not meet spenddown until the baby is born, the woman is considered eligible for family planning services.  Family planning begins after the post partum period.

 

·         Set a tickle to screen a P05 AU for the month after the post partum period ends. For more information, see Add A Program if the P99 is still active or see Screening a Client if the AU has closed.

 

Modification Date: June 20, 2014