A pregnant woman may apply at a qualified provider's office (see 471 NAC 28-001.01) for ambulatory prenatal services. The provider makes a presumptive determination of the woman's eligibility based only on declared income and citizenship/eligible alien status. Income of the woman and spouse (if he is in the home) or the responsible parent(s) of a pregnant minor is counted. The provider does not investigate resources or other eligibility requirements. For income levels, see 471-000-202.
The provider must forward the application, along with the attestation form if applicable, to the Department within five working days after the determination of presumptive eligibility. The application date is the date the provider determines presumptive eligibility for assistance. The presumptive eligibility form is an application for medicaid for the pregnant woman program and serves as verification for pregnancy. This form also serves as a Medicaid application for the pregnant woman's children. The presumptive application includes the requirement of attestation of citizenship/eligible alien status, third party liability insurance cooperation, child support cooperation, and options to claim good cause. Upon receiving the presumptive eligibility form, the Department opens the PE case on N-FOCUS and also pends the pregnant woman and children listed on the application. The Department reviews the application and mails a verification checklist requesting all the verifications needed to determine eligibility. The presumptive case remains open until a determination of eligibility is made. The determination of eligibility must be made within 45 days. PE will automatically close when Medicaid is approved or denied. A presumptive application approved in error will be closed by the Department upon discovery of the error. The Department is not required to notify the woman that her PE case has been closed, but the Department is required to send notice when Medicaid eligibility has been determined.
A pregnant woman may receive only one period of presumptive eligibility per pregnancy.
The presumptive provider must have the pregnant woman complete an LB403 attestation form and submit it with the MS-91.
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