MPW Received after Pregnancy Ended

Applications for MPW after the pregnancy has ended, or child has been born, are to be treated differently. The dates should be entered in a specific way so the participant receives postpartum coverage at the same LOC they were receiving when pregnancy ended.

 

**If the pregnancy evidence already exists, refer to EDITING PREGNANCY DUE DATE or ENDING PREGNANCY guides.

 

**If the application for MPW was received prior to birth of the child, refer to ADD PREGNANCY.

 

ADD MPW APPLICATION AFTER PREGNANCY HAS ENDED

 

    1. From the Integrated Case page tab > Evidence sub-tab > Dashboard folder
    2. Hover cursor over the Pregnancy hyperlink> Click Add Evidence
    3. Complete all required fields
      1. Received Date:
        • If the pregnancy ended the same month if was reported, use the date it was reported.
        • If the pregnancy ended in a month before it was reported, use the date the pregnancy ended.
      2. Case Participant> Click Drop-down menu> Select participant whom you want to add the pregnancy
      3. Number of Unborn Children: Enter the number of unborn children the participant was carrying before the pregnancy ended.
      4. Due Date: Use the date the pregnancy ended. This should match the Pregnancy End Date field.
      5. Pregnancy End Date: Use the date the pregnancy ended   NOTE: Do NOT enter the Pregnancy End Date in the End Date field.  End Date field should be blank.
      6. Start Date: 
        • If the pregnancy ended the same month it was reported, use the 1st day of the month the pregnancy was reported.
        • If the pregnancy ended in a month before it was reported, use the 1st day of the first Prior Quarter (PQ) month the participant would have been eligible based on the birth of the child or the 1st day of the month the pregnancy end date occurred.
          • If the pregnancy ended on the 1st day of the month, use the 1st day of the previous month as the start date.

NOTE: PQ eligibility should only be explored if requested. If the mother was receiving a full benefit package in the 3 months, or the month when the pregnancy is reported, PQ cannot be granted even if eligibility exists.

      1. Postpartum Details:
        1. Check the box Pregnancy Not Reported Timely if the pregnancy was reported more than 10 days after the pregnancy ended.
        2. Only enter a date for Postpartum End Date if the participant:
          1. Voluntarily requests coverage closed
          2. Moved out of state
          3. Was incorrectly determined eligible because of agency error, fraud, or abuse
          4. Is in their postpartum period under a CHIP level of care and is opting to transition to a non-CHIP level of care
    1. Click Save
    2. If PQ is requested and applicable, Enter PQ information.

NOTE: Do not enter PQ evidence if mother was receiving UWHS during the requested PQ months. This will cause an overlap of existing benefits and PQ benefits, resulting in downstream issues.

    1. Complete Verifications
    2. Apply, Review, and Authorize Changes

NOTE: MEDES may generate an additional proposed determination, especially in cases with income changes, adding a person, or removing a person. If the system generated an additional proposed determination, you must review and finalize the proposed determinations again.

    1. Make a comment on the HoH Person Page to include:
      1. Pregnancy ending
      2. Any Coverage Changes