Pregnancy Verification Not Needed

Need Some Crowns? Lost Your Eyeglasses?

 

Montana’s Medicaid eligibility workers are aghast. Hearing this rule change made their jaws drop. Prior to October 1, 2013, for a woman to obtain Medicaid[1] because she is low income and pregnant, she had to provide a doctor’s verification[2] of the pregnancy. The new rule allows the woman to claim pregnancy without a doctor’s verification.

 

Here is the rule:

 

Do not begin Medicaid for a pregnant woman before the first day of the month her pregnancy began. Staff must verify the month the pregnancy began. The applicant’s (pregnant woman’s, case name’s or authorized representative’s [AR’s]) verbal or written statement of the start month, the number of expected children and anticipated date of delivery is an acceptable source of verification[3], …

 

And further,

Verify pregnancy by using:

  • Form H3037, Report of Pregnancy;
  • another document containing the same information as Form H3037; or
  • applicant’s (pregnant woman’s, case name’s or AR’s) verbal or written statement of pregnancy, including start month, number of children expected and anticipated date of delivery.

The verification must be provided by an acceptable source such as:

  • a physician;
  • a hospital;
  • a family planning agency;
  • a social service agency; or
  • the applicant.

 

This alarms Montana employees of the Department of Public Health and Human services working in the Office of Public Assistance (OPA). They imagine a 60-year-old woman applying and stating that she is pregnant, thus qualifying for full Medicaid[4]. They cannot state the obvious, that 60-year-old women do not get pregnant, and disqualify her application for Medicaid; they have to accept her statement. She proceeds to get a panoply of services, then calls OPA and says she had a miscarriage, cancelling her Medicaid enrollment.

It appears that any income qualified[5] female from age 0-90, for a period of about nine months, can receive full Medicaid by merely stating that she is pregnant. This is an open invitation to many more applicants and recipients.


[4] Full Medicaid is vision, dental and all medical services. “Medicaid recipients get either full or basic Medicaid coverage depending on which eligibility group they fall into. You may be eligible for full coverage if you are: Under age 21, Blind or disabled, age 65 or older, pregnant. That means you can get all services that Medicaid covers that are medically necessary.” Basic Medicaid excludes “dental care, audiology services, vision exams, eyeglasses, durable medical equipment, and personal-care services in your home.” http://www.dphhs.mt.gov/medicaid/eligibility.shtml

[5] Income less than 150% of federal poverty level, excluding some forms of assistance, and assets less than $3,000 excluding home, one vehicle with the highest equity value and any income producing vehicles.

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