See ACES Screens and Online Pages for an example of pages or screens used in this chapter.
All P99 AUs are processed by Health Care Authority (HCA) users and assigned to Region 9 in one of the following MAGI CSO’s:
Pregnant woman who meet the criteria in Apple Health Eligibility Manual - WAC 182-505-0115 Washington apple health - Eligibility for pregnant women are eligible for P99 medical.
P99 medical is certified to the end of the final month of the base period as described in the Apple Health eligibility manual – WAC 182-505-0115 Washington Apple Health - Eligibility for pregnant women
The base period should be through the end of the final month of pregnancy, not to exceed six months. For additional information, see:
When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).
If an application is not submitted and eligibility determined prior to the end of the pregnancy, the 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.
To screen P99 medical, take the following steps:
To process a pending P99 AU, follow the steps in the Process Application Months and Finalize Application chapters.
For additional information, for information on the Spenddown process, see Apple Health eligibility manual – Apple Health for the Medically Needy and Spenddown overview.
To enter medical expenses to meet the client’s Spenddown liability on a P99 AU in MA Spenddown (M) status, see Spenddown - Processing - How do I enter medical expenses?
After the expenses have been added, follow the steps in Spenddown - Processing - How do I assign medical expenses and authorize Spenddown?
When the pregnancy ends in a month prior to the original due date entered on the Client Details page, take the following steps:
If the Spenddown is met prior to the birth of the baby and the baby is born early, the Medically Needy Pregnancy Medical with Spenddown (P99) Assistance Unit (AU) certification period cannot be shortened.
Check the certification period, and if the certification period ends after the two months post-partum period, screen a new P99 Assistance Unit (AU) with the correct due date using the steps in Online processing - How do I screen a Medical Needy Pregnancy Medical with Spenddown (P99) Assistance Unit (AU)?
When the pregnancy ends in a month after the original due date entered on the Client Details page, take the following steps:
Medically Needy Pregnancy Medical with Spenddown (P99) does not trickle to a Family Planning (P05) Assistance Unit (AU). If the woman does not meet Spenddown until the baby is born, she 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 additional information, see Add a Program if the P99 is still active or see Screening an Application if the AU has closed.
See ACES Screens and Online Pages for an example of pages or screens used in this chapter.