Section 103.11. Presumptive eligibility for pregnant women.

 

(1)   Requirements. Pregnant women may be determined presumptively eligible for MA on the basis of verification of pregnancy and preliminary information about family income. That determination shall be made by providers designated by the department who are qualified in accordance with this section. A provider qualified to make determinations of presumptive eligibility shall meet the following requirements:

(a) Be certified as an MA provider under ch. DHS 105 ; and

(b) Provide one or more of the following services:

1. Outpatient hospital services;

2. Rural health clinic services; or

3. Clinic services furnished by or under the direction of a physician; and

(c) Receive funding or participate in a program under:

1. The migrant health center or community health center programs under section 329 or 330 of the public health service act;

2. The maternal and child health services block grant programs;

3. The special supplemental food program for women, infants and children under section 17 of the child nutrition act of 1966;

4. The commodity supplemental food program under D.4 (a) of the agriculture and consumer protection act of 1973; or

5. A state prenatal [perinatal] program; and

(d) Have been determined by the department to be a qualified provider under this section.

(2)   Duties and responsibilities.

(a) A qualified provider shall ascertain presumptive MA eligibility for a pregnant woman by:

1. Verifying or obtaining verification of the woman's pregnancy; and

2. Determining on the basis of preliminary information that the woman's family income meets the applicable income limits.

(b) The provider shall inform the woman, in writing, of the determination of presumptive eligibility and that she has 14 calendar days from the date of the determination to file an application for MA eligibility with the county department of social services.

(c) Within 5 working days following the date on which the determination was made, the provider shall in writing notify the department and the agency where the woman will apply for MA eligibility of the woman's presumptive eligibility.

(d) In the event that the provider determines that a woman is not presumptively eligible, the provider shall inform her that she may file an application for MA eligibility at the county department of social services.

History: Cr. Register, February, 1988, No. 386 , 3-1-88; correction in (1) (a) made under s. 13.92 (4) (b) 7. , Stats., Register December 2008 No. 636 .

Note

Although "prenatal" was used in the filed rule order, the department's medical assistance manual uses the term "perinatal". Microsoft Windows NT 6.1.7601 Service Pack 1