Purpose: This section identifies medical programs available only to women. These programs include pregnancy-related medical, postpartum and family planning extension, and the Breast and Cervical Cancer Treatment Program (BCCTP).
A pregnant woman is considered for medically needy (MN) scope of care if she meets the requirements in subsection (1)(a) through (c) of this section and:
Has countable income that exceeds the standard in subsection (1)(d) of this section; and
Has countable resources that do not exceed the standard in WAC 388-478-0070.
A pregnant woman may be eligible for non-citizen pregnancy medical if she is not eligible for medical described in subsections (1) and (2) of this section due to citizenship, immigrant status, or Social Security Number requirements.
A pregnant woman meeting the eligibility criteria in subsection (3) is eligible for:
CN scope of care when the countable income is at or below the income standard described in subsection (1)(d); or
MN scope of care when:
The countable income exceeds the standard in subsection (1)(d); and
The resources do not exceed the standard described in 388-478-0070.
Consider as income to the pregnant woman the amount that is actually contributed to her by the father of her unborn child when thepregnant woman is not married to the father.
The assignment of child support and medical support rights as described in chapter 388-422 WAC do not apply to pregnant women.
A woman who was eligible for and received medical coverage on the last day of pregnancy is eligible for extended medical benefits for postpartum care for a minimum of sixty days from the end of her pregnancy. This extension continues through the end of the month in which the sixtieth day falls.
A woman who was eligible for medical coverage on the last day of pregnancy is eligible for family planning services for twelve months from the end of the pregnancy even when eligibility for pregnancy was determined after the pregnancy ended.
The Maternity Care Access Act was implemented in 1989. It provides for a package of services for pregnant women who are eligible for DSHS medical programs such as Maternity Support Services. These services are referred to as First Steps Services. Sometimes the pregnant woman's medical programs are also referred to as First Steps.
All pregnant women, whether receiving cash assistance or only medical coverage, are referred to the First Steps Social Worker.
Non-Cooperation with DCS:
A pregnant woman is not required to cooperate with the Division of Child Support during the pregnancy through the end of the post partum period. Therefore even if she is not cooperating, the non-cooperation does not affect her medical benefits.
Program Priorities:
The following priority is used to establish eligibility for pregnant women:
Categorically needy (CN) (P02)
Medically needy (MN) (P99)
Non-citizen pregnancy program for women who do not meet alien status for other medical programs (P04)
NOTE:
Pregnancy medical has continuous eligibility. Changes in income do not affect these medical programs during the certification period.
WORKER RESPONSIBILITIES
Pregnant children:
Determine eligibility for pregnant children under the age of 19 for children's CN medical program (F06), unless the pregnant child is living with her parents and is requesting medical benefits for the pregnancy only. In this case use the P02 program. Children's CN medical has a higher income level and the child continues to be eligible beyond the postpartum extension.
If the child's income exceeds the CNIL, then determine eligibility for the MN program (P99). See: SPENDDOWN.
Consider if there is reasonable cause to report child abuse or neglect. See the CHILD ABUSE AND NEGLECT REPORTINGsection of the EA-Z manual.
Alien:
Determine eligibility for the non-citizen pregnancy program (P04) for aliens who are not eligible for other medical programs. This program has full scope coverage.
If a pregnant alien's income exceeds the CNIL, determine eligibility for the MN program (P99). See SPENDDOWN.
Financial responsibility and pregnant women:
When a pregnant woman is not married to the father of her unborn child, do not consider the income of the father of her unborn child unless he actually contributes an amount.
Count only the income of a pregnant minor's parent(s) that is actually contributed to the pregnant child.
Household size:
Consider the unborn child(ren) when determining the household size. Add one person for each unborn. This applies to all medical programs.
Non cooperation with the Division of Child Support:
A pregnant woman is not required to cooperate with the Division of Child Support for medical programs during the pregnancy and post partum period. If a pregnant woman receives TANF and is coded in ACES for non cooperation with DCS, open pregnancy medical (P02/P04) so that her medical benefits do not end.
Applications made after the pregnancy ends:
The client is not eligible for the two-month postpartum medical extension, when medical care is authorized retroactively to cover the pregnancy; and
The client is eligible for the twelve-month medical extension for family planning services, even if she is determined eligible retroactively to cover the pregnancy after the pregnancy ends.
End of the pregnancy:
If the pregnancy ends before the expected due date through birth, miscarriage, or abortion, correct the estimated date of delivery on the DEM1 Screen in ACES to ensure a timely program change to family planning services (P05).
Adjust the review date to ensure the client gets additional CN coverage if the pregnancy ends in a month later than the expected due date.
When a woman is terminated from a cash grant and is not eligible for any other medical program, review for eligibility for family planning services if her pregnancy ended in the previous twelve-month period.
Case Pending Spenddown:
When a pregnant woman applies for medical before the baby is born but does not meet spenddown until the baby is born, the woman is considered eligible for medical benefits at the time of the baby’s birth. Therefore, the woman is eligible for:
The extended post partum care: and
Family planning services.
The base period should be through the end of the month in which the baby is due but not to exceed 6 months.
Post Partum Period and Family planning extension:
ACES continues the Pregnancy Medical benefits until the end of the month of the 60th day after the pregnancy ends (post partum period) as long as the mother received Medicaid at the time of the baby's birth. ACES automatically trickles to the Family Planning Medical for the ten month period after the pregnancy medical benefits end unless an eligibility review has been received in the ECR. If an eligibility review has been received in the ECR, a "Y" will be auto populated in the ELIG RVW RCVD field on the MISC screen in order to keep P02 open through the medical re-determination process. If not eligible for any other medical program, enter a "Y" in the CALC ELIG IND field in order for P02 to trickle to P05.
Newborn Medical Coverage:
The newborn is covered for medical services under the mother’s medical identification (ID) card during the mother’s post partum period as long as the mother received Medicaid at the time of the baby’s birth. When the household reports the birth of the baby:
Open the baby on F05 medical as soon as you get all the necessary information such as the baby’s name and birthdate; and
Explain to the household that the mother’s medical ID card must be used for the newborn's medical services through the post partum period as ACES will not print a medical ID card for the baby’s AU until after the post partum period ends.
WAC 388-462-0020 Breast and cervical cancer treatment program (BCCTP) for women--Client eligibility
Effective July 1, 2001, a woman is eligible for categorically needy (CN) coverage under the BCCTP only when she:
Has been screened for breast or cervical cancer under the center for disease control (CDC) breast and cervical cancer early detection program (BCCEDP);
Is found to require treatment for either breast or cervical cancer or for a related precancerous condition;
Is under sixty-five years of age;
Is not eligible for another CN Medicaid program;
Is uninsured or does not otherwise have creditable coverage;
Meets residency requirements as described in WAC 388-468-0005;
Meets Social Security Number requirements as described in WAC 388-476-0001; and
Meets citizenship and alien status requirements as described in:
The certification periods described in WAC 388-416-0015 (1), (4), and (6) apply to the BCCTP. Eligibility for Medicaid continues throughout the course of treatment as certified by the CDC-BCCEDP.
Income and asset limits are set by the CDC-BCCEDP.
The Department of Health (DOH) administers the CDC-BCCEDP program for the State of Washington through their Breast and Cervical Health Program. This program provides breast and cervical cancer screening services for low-income women. CDC also directly contracts with certain tribal entities for this screening service. Until recent passage of federal and state legislation, many of these women did not have access to medical coverage for treatment of the breast and cervical cancer identified through the above screening services.
A woman can access the BCCTP only through a CDC-BCCEDP facility. When a woman meets the eligibility criteria, staff at a CDC-BCCEDP facility will send Medical Eligibility Determination Services (MEDS) the application developed specifically for this program.
A woman who is not eligible for the BCCTP solely because she does not meet the citizenship or alien status requirements described in WAC 388-462-0020(2), is eligible for medical coverage under the Alien Emergency Medical Program. The woman is related to a Medicaid program through the BCCTP and the need for cancer treatment meets the emergency medical condition criteria. For more information on the AEM program, refer to the Emergency Assistance chapter.
NOTE:
Although men may be diagnosed with breast cancer, the federal requirements of this Medicaid program limit medical coverage to only womenas described in this section.
WORKER RESPONSIBILITIES
If a woman contacts CSO staff about this program, refer the woman to:
MEDS at 1-800-204-6429, if she is already receiving coverage under the BCCTP; or
Her local Breast and Cervical Health provider, as described in Clarifying Information - 1. when she wants screening services for breast and cervical cancer and has not yet been diagnosed. The Department of Health web site provides a list of screening clinics.
Notify MEDS if a woman who is receiving coverage under the BCCTP applies and is found eligible for another CN medical program. MEDS will then terminate BCCTP coverage.
If a woman applies in the local CSO and is found eligible for GA cash assistance, she continues to be eligible for CN coverage but not under the BCCTP program. Notify MEDS to terminate coverage under the BCCTP program. Until ACES support for this program is completed, open GAX. At incapacity review, determine whether the client is still receiving the prescribed course of treatment for breast or cervical cancer.
