Apple Health for Pregnant Women
- MN (P99) VERSUS QHP – PROCESSED BY MEDS STAFF
Pregnant women are identified through a barcode report run by MEDS staff.
- Send a letter through Healthplanfinder (HPF) offering medically needy (MN) coverage by meeting a spenddown. Included in this letter is the denial text if no response is received.
- If the pregnant woman responds via phone call:
- Ask if she incurs child care costs; pays out child support; and if retroactive coverage is needed;
- Process P99 in ACES.
- If the pregnant woman responds via mail:
- Process P99 in ACES.
- End of the pregnancy:
- For MAGI, click on the report a change link in the Healthplanfinder and update the pregnancy end date to the date the pregnancy ended.
- For P99, if the pregnancy ends before the expected due date through birth, miscarriage, or termination, correct the estimated date of delivery on the DEM1 Screen in ACES to ensure a timely program change to family planning services (P05).
- Adjust the review date to ensure the woman gets additional CN coverage if the pregnancy ends in a month later than the expected due date.
- Newborn Medical Coverage:
Note: It is important to add the newborn to Apple Health for Newborns (N10) as soon as possible after birth, so the baby has its own client identification number. This can avoid coverage problems for the baby.
- If the mother is served fee-for-service on the date of the baby's birth, a newborn is covered by Medicaid fee-for-service under the mother's client ID through the month that includes the baby's 60th day of life.
- Managed care organizations (MCOs, Healthy Options) will only cover a newborn on the mother’s client ID up to a maximum of 21 days after the birth of the baby. After that, a newborn must have his or her own client identification number, or the only medical coverage the newborn receives is fee-for-service, up through the month that includes the baby’s 60th day of life, or until the newborn is assigned his or her own client ID number, whichever is earlier.
- Once the newborn has been issued his or her own client ID number, the newborn cannot use the mother's client ID. Individuals who have questions regarding their eligibility for MAGI-based medical assistance should call the Medical Eligibility Determination Service at the Health Care Authority at 855-923-9357. Individuals who have questions about applying online for MAGI-based medical assistance should call the Health Benefit Exchange at 855-923-4633.
When contacted about this program, refer all inquiries to the nearest local DOH/Breast and Cervical Health provider for women requesting screening services for breast and cervical cancer and/or has not yet been diagnosed. The Department of Health website provides a list of screening clinics. At their website, click the appropriate county.
- If an application/review is received in the local CSO indicating breast cancer; screen S02, determine eligibility for the SSI-related program and refer her to the local BCCTP provider (insert DOH website).
- Send an email to AskMAGI@hca.wa.gov when a woman is active on BCCTP (S30), applies, and is determined eligible for another CN medical program in order to terminate BCCTP (S30) coverage.
- If a woman applies in the local CSO and is found eligible for ABD cash assistance, she continues to be eligible for CN coverage, however, not under the BCCTP program. Send an email to AskMAGI@hca.wa.gov to notify MEDS to terminate coverage under the BCCTP program. At incapacity review, determine whether the individual is still receiving the prescribed course of treatment for breast or cervical cancer.