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Pregnant person counts as 2 for purposes of Medicaid #5248

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CalebPena opened this issue Oct 17, 2024 · 1 comment · Fixed by #5249
Closed

Pregnant person counts as 2 for purposes of Medicaid #5248

CalebPena opened this issue Oct 17, 2024 · 1 comment · Fixed by #5249
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medicaid Medicaid and related health programs

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@CalebPena
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CO regs: https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=11618&fileName=10%20CCR%202505-10%208.100

@CalebPena CalebPena added the medicaid Medicaid and related health programs label Oct 17, 2024
@CalebPena CalebPena self-assigned this Oct 17, 2024
@MaxGhenis
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From page 58 of that document:

When a household includes a pregnant woman, regardless of the Medical Assistance category, the pregnant woman is counted as herself plus the number of children she is expected to deliver.

This CMS document provides more guidance:

For Medicaid eligibility, if a pregnant woman is seeking an eligibility determination for herself, she is counted as one person plus the number of children expected to deliver. However, if a pregnant woman is in the household of someone who is seeking a Medicaid eligibility determination, states can opt to count her as one person, two people, or one person plus the number of children expected.

I'll merge #5249 as it gets us closer to the right logic, especially in Colorado. I also filed #5250 and #5251 to improve the logic.

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