M E M O R A N D U M

IM-7  01/28/99  EXTENDED WOMEN'S HEALTH SERVICES


SUBJECT:
Extended Women's Health Services
 
DISCUSSION:
As a part of Missouri's Medicaid 1115 Waiver, uninsured women losing MC+ for pregnant women (MPW) eligibility 60 days after the birth of their child will remain eligible for coverage of women's health services.  The coverage will continue for a maximum of two years any time MC+ eligibility due to pregnancy expires.  There is no income limit.  Eligibility will automatically extend following the current 60 day post -partum period.  Because this process will be done systematically based on the insurance information in Field 13-O3, it is very important this information be accurate. 

The participant must not currently have insurance that provides coverage for physician's services and hospitalization.  The requirement that health insurance not have been dropped in the last six months does not apply.  All of the other uninsured requirements for MC+ level of care "1" and "2" children (refer to Memorandum IM-87 dated July 23, 1998) apply.

COVERED SERVICES:

Women in this category are eligible for a two year period for the following services only:

  • Approved methods of contraception;

    •  
  • Pap test;

    •  
  • Pelvic exams;

    •  
  • Sexually transmitted disease testing and treatment;

    •  
  • Family planning, counseling, education on various methods of birth control, and;

    •  
  • Drugs, supplies, or devices related to the women's health services described above, when they are prescribed by a physician or advanced practice nurse.
There will be no cost sharing for this coverage.  Services will be obtained fee-for-service through Medicaid providers in all areas of the state. 

A new level of care (LOC), "O", has been implemented for this group of eligibles. 

Data Processing will systematically convert pregnant women on MPW cases at the end of the 60 day post-partum period if the indicator in Field 13-O3 reflects they are uninsured or HIPP.  This will be done the night prior to the second payroll closing date.  The following changes will occur in the IMU5 system:

  • Field 13G will change to LOC "O";

    •  
  • Field 13E will show a Medicaid start date that is the day after the 60 day period ended, and;

    •  
  • Field 32 will reflect a closing date 24 months after the end of the 60 day period.
The attached notice will be systematically generated to those participants eligible for Extended Women's Health Services.  The notice will explain changes in coverage and effective dates of coverage. 

Those MPW recipients with an "I" (insured) in Field 13-O3 will continue to be systematically closed on the second payroll closing at the end of the 60 day postpartum coverage period.  If there is a newborn on the case, only the pregnant woman will close, not the case.

The system will generate a letter to recipients with an "I" in Field 13-O3 advising when their post-partum coverage will end and the reason they do not qualify for the two year extension for women's health services.  They are advised to notify their caseworker immediately if they no longer have health insurance.  If you are contacted by a recipient who states they no longer have health insurance, update field 13-O3 to reflect uninsured immediately so the case may be converted to the new extended coverage.

OTHER CHANGES:

If the woman becomes pregnant again while the Extended Women's Health Services case is active, it will be necessary to register a R2 application.  Close the Extended case upon approval of the R2 case, unless there is a newborn on the case.  If there is a newborn on the Extended case, remove the mother and the Medicaid termination date in field 32.  This will allow the newborn to continue on the R1 case until they reach one year of age.

The woman may qualify for MC+ or another Medicaid program with more extensive coverage.  If so, she must complete an application before eligibility can be determined.  Anytime the Extended case is closed, the woman cannot regain eligibility for Extended Women's Health Services for the remaining two year period.
 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
CSW
Distribution #6
[ 1999 Memorandums ]
MC+ Service Center
address
address
 
 
 

Effective ______________ your MC+ sixty (60) days of post-partum coverage will end.  As an uninsured woman  you are eligible for women's health services for up to two years after your post-partum coverage expires.  Your eligibility for this MC+ extension will begin effective _____________ and continue through _____________, unless you apply and qualify for another MC+ program or obtain other health insurance.

Covered women's health services include the following:

o Approved methods of birth control;
o Pap test;
o Pelvic exams;
o Sexually transmitted disease testing and treatment;
o Family planning counseling/education on various methods of birth control; and
o Drugs, supplies, or devices related to the women's health services described above, when they are prescribed by a physician or advanced practice nurse.

Call the Recipient Services Information Line at 1-800-392-2161 to inquire about covered services or providers.  There will not be cost sharing for this coverage.  These services are to be obtained through state approved MC+ health care providers.

Custodial parents with income below 100% of the Federal Poverty Level may qualify for MC+ coverage of additional services.  Persons under age 19 with income under 300% of the Federal Poverty Level may also qualify for MC+ coverage of additional services.  Please contact me if you wish to apply.

It is important that you notify us if you move or obtain health insurance coverage.  PLEASE REPORT THE BIRTH OF YOUR CHILD, IF YOU HAVE NOT ALREADY DONE SO, SO THAT HE OR SHE MAY ALSO RECEIVE MC+ COVERAGE.

      Sincerely,
 
 

      MC+ Service Representative
      Phone:
      Load:

POLICY NO.___________________ 


 MC+ Service Center
address
address
 

Effective _____________ your MC+ sixty (60) days of post-partum coverage will end.  Uninsured women are eligible for MC+ coverage for women's health services for up to two years after your post-partum coverage expires.  Our records indicate you are currently insured, therefore, you do not qualify for this additional coverage.  

IF YOU NO LONGER HAVE HEALTH INSURANCE COVERAGE, IT IS IMPORTANT THAT YOU CONTACT ME IMMEDIATELY SO OUR RECORDS CAN BE CORRECTED.

You have the right to appeal decisions made involving your coverage.  You can request a hearing within 90 days from the date of this notice by contacting your MC+ Service Representative.  If you request a hearing you may present your information yourself or you may be represented by your own attorney or by other persons who know your situation.  You have the right to present witnesses in your behalf and to question witnesses who appear at the request of the MC+ Service Representative.

Insured persons under age 19 with income up to 100% of the Federal Poverty Level can qualify for MC+ coverage.  Insured parents over age 19, with very low income, may also qualify. Please contact me or call 1-888-275-5908 if you wish to apply.

PLEASE REPORT THE BIRTH OF YOUR CHILD, IF YOU HAVE NOT ALREADY DONE SO, SO HE OR SHE MAY ALSO RECEIVE MC+ COVERAGE.

      Sincerely,
 
 

      MC+ Service Representative
      Phone:
      Load:
 

Policy No.