005.01
ELIGIBILITY
REQUIREMENTS. A pregnant womanwho is not otherwise eligible for
Medicaid or Children's Health Insurance Program (CHIP)may have her unborn
child's eligibility reviewed under the 599 Children's Health Insurance Program
(CHIP) program. Eligibility for Medicaid must first be determined before 599
Children's Health Insurance Program (CHIP) eligibility can be reviewed.
Eligibility is determined for unborn children from conception through birth, if
the household income is equal to or less than 197% of the Federal Poverty Level
(FPL).
005.01(A)
CITIZENSHIP AND
NON-CITIZEN STATUS. 599 Children's Health Insurance Program (CHIP)
has no requirement for citizenship or alien status, as the unborn child's
status is independent of that of the pregnant woman.
005.01(B)
CREDITABLE HEALTH
INSURANCE. There is no eligibility for the unbornchild if the
pregnant woman has creditable health insurance. Health insurance which does not
provide prenatal or maternity care is not considered creditable coverage. For a
definition of creditable health insurance, see 477 NAC 1.
005.01(C)
NEBRASKA
RESIDENCE. The residency of the unborn child will follow the
residency of the pregnant woman.
005.01(D)
RELATIVE
RESPONSIBILITY. Relative responsibility in the 599 Children's
Health Insurance Program (CHIP) is determined using relative responsibility
regulations for modified adjusted gross income (MAGI) programs. For a pregnant
minor, the income of her financially responsible parents shall not be used to
determine eligibility for the unborn child.
005.01(E)
AGE
REQUIREMENT. For receipt of 599 Children's Health Insurance
Program (CHIP) benefits, an individual is considered an unborn child from
conception until birth.
005.01(F)
THIRD PARTY LIABILITY. If an ineligible pregnant woman
or her spouse fails or refuses to cooperate with third party liability, the
unborn child is ineligible for 599 Children's Health Insurance Program
(CHIP).
005.02
EFFECTIVE DATE OF ELIGIBILITY. The effective date of
eligibility for 599 Children's Health Insurance Program (CHIP) is no earlier
than the first day of the application month. There is no retroactive
eligibility for 599 Children's Health Insurance Program (CHIP).
005.03
CONTINUOUS
ELIGIBILITY. Unborn children are continuously eligible for up to
six months or through their month of birth, whichever comes first. After six
months of continuous eligibility, a full eligibility review is not required.
However, information reported or known to the Department must be acted upon. An
unborn child must have at least a thirty day period of ineligibility before he
or she would qualify for another sixmonth period of continuous eligibility.
005.03(A)
ELIGIBILITY FOR THE
CHILD UPON BIRTH. Following the birth of the child, eligibility
will be determined for medical assistance based on any changes reported or
known to the Department. If the newborn is determined eligible for medical
assistance, the newborn is eligible for six months of continuous Medicaid
eligibility.
005.03(B)
POST-PARTUM SERVICES. The pregnant woman will not be
eligible for post-partum services under 599 Children's Health Insurance Program
(CHIP). If post-partum care is needed for complications following labor and
delivery, the woman may apply for Emergency Medical Services Assistance
(EMSA).
