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Presumptive Eligibility for Pregnant Women - Medical Assistance - Iowa

A pregnant woman can file an application with a qualified provider to obtain Medicaid payment for ambulatory prenatal care services. If the pregnant woman requests eligibility only for ambulatory prenatal services, she will remain eligible through the end of the month following the month in which she is determined eligible for these services.

If the pregnant woman also formally applies for Medicaid at the same time, she will remain eligible for the period of time it takes DHS to process her Medicaid application. In either case, this is referred to as presumptive eligibility.

"Ambulatory" prenatal care includes all Medicaid-covered services except inpatient hospital care and services associated with the delivery of the baby or with a miscarriage or termination of pregnancy.

Since virtually any medical condition that affects the health of the mother could potentially affect the health of the unborn child, all ambulatory medical care is covered. Ambulatory prenatal care services received during the time the woman is presumptively eligible will be paid even if DHS does not approve the woman for Medicaid.

Inpatient hospital care and other charges associated with an inpatient stay are not covered. If the pregnant woman incurs bills from an inpatient hospital care (e.g., when the baby is born), these services are not paid unless the Department determines that the woman is Medicaid-eligible and approves her application for assistance.

The pregnant woman has until the last day of the month following the month of the presumptive eligibility determination to file a formal Medicaid application with DHS. If the woman files a Medicaid application, presumptive Medicaid eligibility continues until the Department approves or denies the Medicaid application.

If the woman does not file a Medicaid application by the end of the last day of the month following the month of the presumptive eligibility determination, presumptive eligibility ends on the last day of that month.

See Also:

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter F, Coverage Groups, Presumptive Eligibility for Pregnant Women

Legal reference: 441 IAC 75.1(30)

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