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Implementation Guide: Medicaid State Plan Eligibility Eligibility Groups – Mandatory Coverage Pregnant Women

Guidance for the reviewable unit (RU) that describes the consolidated Medicaid eligibility group for pregnant women, as described at 42 CFR 435.116. It provides the criteria under which individuals may be covered under this group, the income standard used, and the basis for the income standard used. In addition, this RU describes the benefits provided to pregnant women; specifically, whether the state provides full Medicaid coverage to all pregnant women in this eligibility group or limits coverage for those with income above a certain standard to services covered under the state plan which are related to pregnancy.

Download the Guidance Document

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 01, 2019

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.