225 PREGNANT WOMEN MEDICAL ASSISTANCE (MAM)

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Pregnant women may be of any age to be eligible for one of the following medical assistance coverage groups:

Pregnant Women MA

Pregnant Women medical assistance (MA) is a Medicaid eligibility category that uses Modified Adjusted Gross Income (MAGI) in the eligibility determination process.

·         The woman must be pregnant.

·         At application, countable income must equal or be less than 196% of the federal poverty level (FPL). 

Qualified Pregnant Women (In and Out Medical Assistance)

This Medicaid eligibility category does not use MAGI in the eligibility determination process.

·        The woman must be pregnant.

·        Countable income must exceed the income limit for Pregnant Women MA.

·        Determine the spenddown amount for In and Out medical assistance by using the PIL. This spenddown amount cannot increase unless the spenddown is not met for any month. If the spenddown is not met in one of the coverage months and the income increased in any of the coverage months after the spenddown was determined, calculate a new spenddown amount.

·        If a spenddown is met during the pregnancy period, continue eligibility regardless of income through their pregnancy until the end of the 12 month postpartum period and does not have to meet a spenddown in a subsequent month

·    Compare countable resources to the medically needy resource limit in Section 407.03, Medically Needy Medical Assistance.

Up to three periods of retroactive medical assistance are available to pregnant women applying for assistance if all other eligibility requirements are met.

References: He-W 845, RSA 167:68,I, 42 CFR 435.116, 42 USC 1396a (l)(1)(2)(A)(i)