GIS 14 MA/022:Medicaid Eligibility for Pregnant Minors

To:All Local District Commissioners, Medicaid Directors,

From: Judith Arnold, Director
Division of Eligibility and Marketplace Integration

Subject: Medicaid Eligibility for Pregnant Minors

Effective Date:July 1, 2014

Contact Person: Local District Support Unit
Upstate (518) 474-8887 NYC (212) 417-4500

The purpose of this Office of Health Insurance Programs General Information System (GIS) message is to advise local departments of social services (LDSS) of changes to Medicaid eligibility for pregnant minors.

Prior to the implementation of the Affordable Care Act, parental income was disregarded for pregnant minors. Income disregards are no longer allowed under the Modified Adjusted Gross Income (MAGI) methodology. Therefore, in order to continue the practice of not counting parental income, the Department requested an amendment to the Medicaid State Plan to include a reasonable classification for pregnant individuals under the age of 21, which does not require a determination of income for this category.

The Department received approval of the State Plan Amendment from the Centers for Medicare and Medicaid Services (CMS) to authorize Medicaid benefits to pregnant minors without an income test. A pregnant minor is identified as a female under the age of 21 who states she is pregnant.

All other policies, procedures and coding for pregnant women remain in effect for pregnant minors.