Current through Register Vol. 50, No. 9, September 20, 2024
A. Pursuant to
the provisions of the Omnibus Budget Reconciliation Act of 1986, the Department
of Health, Bureau of Health Services Financing shall provide health care
coverage through the LaMOMS Program to Medicaid eligible pregnant women with
low income under the Medicaid state plan.
B. Eligibility Requirements. Eligibility for
LaMOMS coverage may begin at any time during a pregnancy, and as early as three
months prior to the month of application. Eligibility cannot begin before the
first month of pregnancy. The pregnant woman must be pregnant for each month of
eligibility, except for the 12-month postpartum period.
C. Financial Eligibility. Effective January
1, 2014, the LaMOMS Program shall provide Medicaid coverage to pregnant women
with family income up to 133 percent of the federal poverty level. For
applicants with income above 133 percent of the federal poverty level, 5
percent of the federal poverty level shall be disregarded from their income.
1. Changes in income shall be disregarded
during the period of pregnancy and for the 12-month postpartum
period.
D. The LaMOMS
program shall provide Medicaid coverage for:
1. prenatal care;
2. delivery;
3. conditions which may complicate the
pregnancy; and
4. postpartum care
during the 12-month postpartum period.
E. Certification Period
1. Eligibility for the pregnant women group
may begin:
a. at any time during a pregnancy;
and
b. as early as three months
prior to the month of application.
2. Eligibility cannot begin before the first
month of pregnancy. The pregnant women group certification may extend through
the calendar month in which the 12-month postpartum period ends.
3. An applicant/enrollee whose pregnancy
terminated in the month of application or in one of the three months prior
without a surviving child shall be considered a pregnant woman for the purpose
of determining eligibility in the pregnant women group.
4. Certification shall be from the earliest
possible month of eligibility (up to three months prior to application) through
the month in which the 12-month postpartum period ends.
5. Retroactive eligibility shall be explored
regardless of current eligibility status.
a.
If the applicant/enrollee is eligible for any of the three prior months, she
remains eligible throughout the pregnancy and 12-month postpartum period. When
determining retroactive eligibility, actual income received in the month of
determination shall be used.
b. If
application is made after the month her pregnancy ends, the period of
eligibility will be retroactive but shall not start more than three months
prior to the month of application. The start date of retroactive eligibility is
determined by counting back three months prior to the date of application. The
start date will be the first day of that month.
6. Coverage during the 12-month postpartum
period is only available to an individual who is eligible for medical
assistance under the state plan while pregnant, including during a period of
retroactive eligibility.
7.
Eligibility may not extend past the month in which the 12-month postpartum
period ends.
a. The 12-month postpartum period
begins on the last day of pregnancy.
b. The 12-month postpartum period ends the
last day of the month in which the 12-month postpartum period has
expired.
8. The
applicant/enrollee must be income eligible during the initial month of
eligibility only. Changes in income after the initial month will not affect
eligibility.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
