Current through all regulations passed and filed through September 16, 2024
(A) This rule
describes eligibility for pregnant individuals as described in
42 C.F.R.
435.116 (as in effect on October 1,
2023) for
applications for medical assistance.
(B) Eligibility criteria for coverage because
an individual is pregnant.
(1) The individual
must be female and pregnant.
(2) A
statement from the individual, a physician, or managed care
organization
(MCO) is sufficient verification of pregnancy, unless the administrative
agency has information contradicting the individual's statement.
Self-attestation of pregnancy is acceptable unless
available information conflicts with the attestation or the woman is pregnant
with more than one fetus.
(3)
The individual's household income must not exceed two hundred per cent of the
federal poverty level for the family size. For the purpose of this rule, family
size includes the number of fetuses.
(4) An individual who is in her postpartum
period, as defined in rule
5160:1-1-01 of the
Administrative Code, is also eligible under the criteria described in this
rule.
(C) Eligibility
span for pregnant individuals.
(1) Once
established, eligibility for a pregnant individual continues throughout
the
pregnancy and postpartum period.
(2) An individual is eligible for postpartum
coverage if she was eligible for medical assistance on the date
the
pregnancy ended. This includes a birth mother whose labor and
delivery services were furnished prior to the date of application and who is
determined eligible for retroactive coverage of labor and delivery services as described in
rule 5160:1-2-01 of the
Administrative Code.
(D)
Administrative agency responsibilities. The administrative agency must:
(1) Calculate a pregnant individual's family
size and household income as described in rule
5160:1-4-01 of the
Administrative Code.
(2)
When a pregnant woman
attests to carrying more than one fetus and the increased family size makes her
income eligible for medical assistance, the administrative agency shall require
the woman to provide verification of pregnancy, including the expected date of
delivery and the number of unborn fetuses, from a licensed medical
professional.
(3) Not
discontinue eligibility for a pregnant individual
during the
pregnancy or postpartum period, unless the
individual dies, moves out of state, or requests that coverage be
discontinued.
(E) Individual responsibilities.
A pregnant
woman must provide verification of pregnancyfrom a licensed medical professional, including the expected
date of delivery and the number of unborn fetuses, only when requested by the
administrative agency.
