SR 23-42 Dated 10/23

SUMMARY

This Supervisory Release (SR) explains a change in the eligibility period for pregnant individuals.  Individuals who are pregnant and enrolled in Medicaid are continuously eligible through their pregnancy and the 12-months following the end of the pregnancy without regards to any change in circumstance.

BACKGROUND

House Bill (HB) 2, Chapter 79, Laws of 2023, authorized the department to extend the postpartum period from 60 days to 12 months.  This amendment allows continuous medical coverage to pregnant individuals through their pregnancy and the 12-month postpartum period.

POLICY

Effective October 1, 2023, individuals who are pregnant and enrolled in Medicaid will remain enrolled through their pregnancy and the 12 months following the end of their pregnancy regardless of any change in circumstance.  This policy pertains to pregnant individuals opened in any category of Medical Assistance.

·        To be eligible for extended postpartum coverage, the individual must have been eligible for and enrolled in Medicaid while pregnant (including during a period of retroactive eligibility in Medicaid)

o   Example:  A pregnant individual applies for medical assistance on October 10, 2023 and requests 3 months retroactive coverage.  Medical assistance will be opened effective July 10, 2023 and will remain continuously eligible without regards to change in circumstances through the end of the 12-month postpartum.

·        The 12-month postpartum period begins on the last day of a beneficiary’s pregnancy (no matter the reason the pregnancy has ended) and extends through the end of the month in which the 12-month period ends. 

·        If the individual becomes pregnant within the 12-month postpartum period, she will remain continuously eligible throughout the new pregnancy and an additional 12-month postpartum period will begin when the subsequent pregnancy ends.

·        The pregnant individual remains open for Medicaid regardless of any change in circumstance including income unless:

o   The individual requests medical assistance to close;

o   The individual moves out of New Hampshire; or

o   The individual passes away.

o   The agency determines that eligibility was determined incorrectly at the most recent determination or redetermination of eligibility because of agency error or fraud, abuse, or perjury attributed to the individual. 

·        Qualified pregnant women (pregnant women with a spenddown) who meet a spenddown, will remain open without having to meet a future month’s spenddown until the end of the 12-month postpartum period.

·        Pregnant individuals enrolled in Medicaid do not have to complete a redetermination until the end of the 12-month postpartum period.  

·        Recipients whose pregnancy ended before 10/1/23, but remain within their 12-month postpartum period, will remain continuously eligible for the remainder of the 12-month postpartum period. 

·        Non-citizen pregnant individuals who are otherwise eligible for Medicaid except for meeting the citizen and immigration requirements, are opened Emergency Medicaid and will be enrolled during the emergency period and receive medical coverage for the emergency service only.  However, the continuous eligibility will remain in place even though the individual’s medical coverage will show as closed in New HEIGHTS.  If additional emergency medical services occur within the pregnancy and the 12-month postpartum period, a new application cannot be required and the Emergency Medicaid for that service shall open. 

NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES

·        New HEIGHTS will now continue eligibility for pregnant individuals through the end of the month in which the 12-month postpartum period ends. 

·        Pregnant individuals open Medically Needy In & Out who meet their spenddown will remain open and not have to meet a future spenddown until the end of the 12-month postpartum period.  New HEIGHTS Help Desk will be receiving a monthly report for individuals that fall under the spenddown criteria and will be acting on these cases to ensure they receive full medical coverage throughout the pregnancy and 12-month postpartum period.

Field Operations

When the pregnancy ends:

·        The date the pregnancy ends (no matter the reason) is entered on the pregnancy end date field.

NOTE:  Do not end date the pregnancy screen until after the 12-month postpartum period has expired. 

·        The FSS will submit a New HEIGHTS Help Desk ticket to change the redetermination date to the month in which the 12-month postpartum period ends. 

This population could be open under any Medicaid category and therefore, it is imperative to check the pregnancy screen to ensure the individual is not pregnant or in the postpartum period.

The only acceptable process in closing medical coverage for a pregnant woman or woman in the postpartum period is when:

·        The individual requests the medical assistance to close.

Ø  Close at the individual level on the POA by selecting the reason, “closed at recipient’s request.”

Ø  Close with 0 ANP only at the recipient’s request.

Ø  Enter a clear and concise case comment

·        The individual moves out of New Hampshire.

Ø  Close at the individual level on the POA by selected, “moved out of New Hampshire.” 

Ø  Close with 0 ANP only at the recipient’s request.

Ø  Enter a clear and concise case comment

·        The individual passes away.

Ø  Close on Additional Demographics-Details screen by completing the date of death field and send the Condolence Letter. 

Ø  Close with 0 ANP.

Ø  Enter a clear and concise case comment

·        The agency determines that eligibility was determined incorrectly

Ø  Close at the individual level on the POA by selected, “error in determining eligibility.”

Ø  Close with normal 10 day ANP.

Ø  Enter a clear and concise case comment.

Closing medical assistance for other household (HH) members:

·        When closing medical assistance for other HH members due to failing to provide required verifications:

Ø  Confirm the medical coverage for the appropriate HH members only (excluding the pregnant individual’s medical coverage).  Once confirmed, return to the appropriate fields and select “not yet verified.”

Redeterminations:

Pregnant individuals enrolled in Medicaid do not have to complete a redetermination until the end of the 12-month postpartum period.  While system changes are being updated, the pregnant individual and postpartum population will continue to have their original cycle redetermination.  If the redetermination application is provided and there is no change in medical coverage, the FSS may confirm the redetermination as completed.  If the redetermination is not completed, or completes the redetermination resulting in a decrease in eligibility, the FSS will not confirm the change.  The eligibility will remain as it is and the FSS will submit a New HEIGHTS ticket to change the redetermination date to the month in which the pregnancy is due. 

Example: 

Jane applies for and is opened GA in November 2022.  Her redetermination is due October 2023.  In August 2023, Jane reports she is pregnant with a due date in March 2024.  If Jane’s pregnancy continues full term and her baby is born in March 2024, Jane will not need to complete a redetermination until February 2025. 

       However, Jane’s redetermination is still set for Oct. 2023.  If Jane completes the redetermination in Oct. 2023 and there is no change in eligibility, the FSS may confirm the redetermination.  If the redetermination is not completed or the redetermination is completed with a decrease in eligibility, the FSS will not confirm the change in medical coverage and instead will submit a New HEIGHTS Help Desk ticket to change the redetermination date to March 2024.

       If at the pregnant individual’s scheduled redetermination, the FSS discovers that the pregnancy ended at an earlier date than expected, the FSS will end date the pregnancy as of the date the pregnancy ended.  The 12-month postpartum period will begin the month in which the pregnancy end date is entered.

If the pregnant individual does not complete the redetermination or attest to the end of the pregnancy, end date the pregnancy using the pregnancy due date. 

DESCRIPTION OF REVISIONS MADE TO FORMS

There are no forms requiring updating due to this change.

POLICY MANUAL REVISIONS

Medical Assistance Manual Topics

Part 225            PREGNANT WOMAN MEDICAL ASSISTANCE

Section 255.01  Continuation of Medical Assistance

Section 255.03  Required Verifications

Section 230.01  Granite Advantage Eligibility Criteria

CLIENT NOTIFICATION

No client notification is planned or needed.

TRAINING

No special training is planned or needed.

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the Online Manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for BFA policy releases. This SR, and revised Online Manuals, will be available for agency staff in the Online Manual Library, and for public access on the Internet at https://www.dhhs.nh.gov/sr_htm/sr.htm, effective January 2, 2024.

BFA/DMS: 23-42 (jl)