Add Pregnancy for Participant on Integrated Case

When a household member on an Integrated Case reports a pregnancy, this evidence must be added.

 

If the reported pregnancy already exists, refer to Editing Pregnancy Due Date or Ending Pregnancy guides.

 

If the application for MPW is presented to FSD after the birth of the child, refer to MPW Application Received After Child is Born

 

Note: If the mother was receiving a full benefit package in the 3 months or the month when the pregnancy was reported, Prior Quarter (PQ) cannot be granted even if eligibility exists.

 

Tools: Date Calculator

 

TO ADD PREGNANCY ON AN INTEGRATED CASE

      1. Navigate to the Integrated Case page tab > Evidence sub-tab > Dashboard folder
      2. Prior to adding Pregnancy Evidence:
        • Check Application Details Evidence to ensure the participant requesting MPW has a ‘Yes’ segment of Application Details. If not, end the ‘No’ segment of Application Details Evidence (if applicable) the date prior and add the ‘Yes” segment of Application Details the date the pregnancy was reported to FSD.
        • Check that the participant requesting MPW has active Citizenship Status evidence, ID Details (SSN number) evidence and MO Medicare Self-Attestation evidence. If any of these evidences are missing, you must add them.
        • If the participant requesting MPW is requesting PQ, check the Eligibility Timeline to determine if they are already receiving benefits and if they are full coverage or UWHS.
      3. Hover cursor over the Pregnancy hyperlink > Click Add Evidence
      4. Complete all required fields
        1. Received Date > Use the date the pregnancy was reported to FSD. 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. Pregnancy Details > Number of Unborn Children: Type the number
        4. Due Date > Enter the due date
            1. If unknown, enter 8 months from the date of application based on the appropriate Level of Care as the due date. Use the Date Calculator to assist in determining this date
        5. Start Date > Use the 1st day of the month the pregnancy was reported to FSD. If requesting and eligible for PQ, use the 1st day of the PQ month the pregnancy began or the 1st day of the month conceived, whichever is later based on the due date.
      1. Click Save
      2. If PQ is requested and applicable, Enter PQ information.

NOTE: If mother has yes app details but not receiving a full benefit package (receiving UWHS during the requested PQ months), do not enter PQ evidence. 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
        2. Any Coverage Changes
      2. Review notice queue to make sure appropriate forms generated
        1. IM-80PRE: generates in the event of coverage is closing and not eligible for any other MAGI coverage
        2. IM-80: generates in the event of coverage changes
        3. IM-33C: case action notice