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Issue Alert - 06-10-02

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Date:

Oct 01, 2006

Program Area:

Medicaid

Issue Summary:

Beginning October 1st, 2006, DHS must process all Medicaid applications within 10 days for applicants who are pregnant

Persons Affected:

Low-income pregnant women who need health insurance

For More Information:

Center for Civil Justice
320 S. Washington, 2nd Floor
Saginaw, MI 48607
(989) 755-3120, (800)724-7441
Fax: (989) 755-3558
E-mail: info@ccj-mi.org

Michigan Poverty Law Program
611 Church Street, Suite 4A
Ann Arbor, MI 48104-3000
(734) 998-6100 (734) 998-9125


Background

The Department of Human Services (DHS) must process applications for assistance programs within specific timeframes from the date that the applicant submits the application to DHS.   In general, DHS has 45 days to process Medicaid applications that do not involve a disability determination.  DHS has 60 days to process Medicaid for applicants where disability determination is part of the eligibility requirements

What's Happening?

In order to ensure that pregnant women get prenatal care as soon as possible,DHS has set a new, 10 day standard of promptness for processing Medicaid applications submitted by pregnant women.  Effective October 1, 2006, all pregnant Medicaid applicants must have their applications processed within 10 calendar days. See Program Policy Bulletin (PPB) 2006-0013 p.2 and Program Administrative Manual (PAM) 115 p.11 (effective 10-1-2006).  DHS’s PPBs and Manuals are available online at http://www.mfia.state.mi.us/olmweb/ex/html/ or by using the “Quick Link” at http://www.mplp.org.

 

The Standard of Promptness starts the day that DHS receives the application with the minimum information required for registration.  Applications with the minimum information include the name, address and birthday of the applicant, and a signature.  See PAM 105 p.1. Applicants also should indicate that they are pregnant on the application, in order to trigger the 10 day standard of promptness.

Pregnant women may apply with either the DHS combined application (a.k.a. the 1171), or the DCH short form (a.k.a.  DCH-0373D). 

 

Pregnant women can apply for Medicaid at any DHS office, their local public health department, or any Federally Qualified Health Center. 

In order to determine eligibility for pregnancy-related Medicaid, DHS also needs information about the income for the member’s of the applicant’s fiscal group (applicant and spouse), their Michigan residence, whether or not the applicant is a U.S. citizen, and the baby’s due date. 

 

To receive Medicaid under the Healthy Kids categories for pregnant women and children, applicants need not verify income unless DHS has information on file that makes the information on the application questionable.  Applicants who are not U.S. citizens should consult an advocate before providing verification of immigration status.  See  Issue Alert 06-04-06 (April 11, 2006).

 

Guarantee of Payment Letters (“GPL”)

Pregnant applicants should also be aware that they should receive a Guarantee of Payment Letter at the time they submit their application to their county public health department or DHS, unless their application is approved the same day it is submitted. See PAM 107. A GPL notifies the applicant’s medical providers that pregnancy-related services will be paid by DCH.  Applicants who are 18 or older are eligible for a GPL if they are pregnant, a Michigan resident and their income is below 185% of the federal poverty level.  Applicants who are 17 or younger can get a GOP letter if they are pregnant and are a Michigan resident.  

 

Emergency Services Only Medicaid (“ESO” Medicaid) and MOMS

Some non-citizens who are undocumented or who have not been in the U.S. for 5 years will not be eligible for full Medicaid and will be approved for Medicaid for Emergency Services Only. ESO Medicaid pays for labor and delivery but not for routine, pregnancy-related care.    In order to receive coverage for routine, prenatal and postpartum care, these pregnant ESO Medicaid recipients need to enroll in MOMS – the Maternity Outpatient Medical Services program, which is funded by the SCHIP (State Children Health Insurance Program) instead of Medicaid.  See Program Eligibility Manual (PEM) 657.

 

There is no separate MOMS application form and it is not clear whether women who apply for Medicaid at DHS instead of at the Health Department will be enrolled in MOMS if they receive ESO Medicaid.  The GPL puts DCH on notice that the woman is pregnant and needs MOMS if she is approved for ESO instead of full coverage Medicaid.   However, it appears that only the Health Departments are actually enrolling pregnant women in MOMS.

 

Pregnant women who are approved for ESO Medicaid should request verification that they are enrolled in MOMS and should seek legal advice if they have not been enrolled in MOMS.  

What Should Advocates Do?

1. Inform pregnant applicants about the new processing deadlines.
2. Advise pregnant women to ask for a GPL when they apply.
3. Advise pregnant women to contact their caseworker or a supervisor if they do not receive a timely eligibility decision. If the delay continues, they should request a hearing and seek legal help.

What Should Clients Do?

Low-income clients who are pregnant and need health insurance should apply for Medicaid at their local DHS office or public health department. You should also ask for a GPL letter when you apply. If you do not receive an eligibility notice within 10 days, you should contact your caseworker or supervisor. If you still have not been notified regarding your eligibility, you should request hearing and contact legal services.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.