MEMORANDUM

DISCUSSION:

This memorandum is to notify staff of a change in the Extended Women's Health Services (EWHS) Program policy. The EWHS Waiver provides family planning services to uninsured women from age 18 up to but not including age 56. Previously, the waiver only covered woman up to age 54. Effective 1/13/2013, FAMIS enhancements were made to accommodate the age limit.

The EWHS Program provides health services for women from age 18 up to but not including age 56 who:

• are uninsured, or who have insurance coverage that does not provide family planning services;
• do not have access to employer-sponsored insurance that covers family planning services;
• are not be eligible for Medicare (this includes Part A);
• are not eligible for any other MO HealthNet program, including the MHABD Spend Down or Non-Spend Down programs;
• lose MO HealthNet for Pregnant Women (MPW) eligibility due to the end of pregnancy; and
• are in need of family planning services.

To be in need of family planning services the woman must be of the child bearing ages of 18 up to but not including age 56 and must not be sterilized. Women who are not in need of family planning services are determined ineligible based on program eligibility factors.

If the eligibility specialist becomes aware that the participant is sterilized, take action to close after the 60 days postpartum has expired. Send the participant a Pre-closing Notice (IM-80PRE) stating the reason for the proposed action and giving the participant 10 days to respond. When the IM-80PRE expires, enter an action of adverse action worker close (AAWC) in FAMIS with the reason code APE – application approved in error. Send the participant an Adverse Action Notice (IM-80) stating the correct reason for closing. A copy of the corrected letter must be filed in the case record.

EXAMPLE: Ms. Jones delivers her child 03/25 by C-Section and notifies her ES that during her C-Section, she had her tubes tied. On 05/01 the ES sends Ms. Jones an IM-80PRE notifying her that her 60 days post partum coverage will end on 5/31. On 05/11 the ES sends Ms. Jones an IM-80 informing Ms. Jones that her 60 days post partum will end on 05/31 and she was not found eligible for another MO HealthNet program.

EWHS coverage will continue for a maximum of one year. Eligibility automatically extends following the end of the 60-day postpartum period for eligible women.

The only healthcare services covered by MO HealthNet under the EWHS program are family planning and family planning related services. The MO HealthNet Division provides guidance to MO HealthNet providers of services covered by the various Medicaid eligibility (ME) codes. Refer to the benefit matrix located under "Covered Services" on the About The MO HealthNet Division webpage for a listing of covered services for all programs. Clarification is added to Income Maintenance manual sections 0925.050.00 and 0925.050.10.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff.

AC/mks