Revision 24-4; Effective Dec. 1, 2024

Pregnant or postpartum women who lose eligibility for the following types of assistance automatically transition to Medicaid for Pregnant Women (TP 40) coverage for the remainder of their pregnancy and 12-month postpartum period:

  • ME - Waivers
  • ME - State Group Home
  • ME - Pickle
  • ME - SSI
  • ME - State School
  • ME - Non-State Group Home
  • ME - State Hospital
  • ME - Medicaid Buy-In
  • ME - Medicaid Buy-In for Children (MBIC)
  • ME - Nursing Facility
  • ME - Disabled Adult Child
  • ME - Disabled Widow(er)
  • ME - Early Aged Widow(er)

Note: ME - Community Attendant is not full Medicaid. Community Attendant Services (CAS) provides payment for attendant care only. Recipients certified on ME - Community Attendant must submit an application to determine eligibility for Pregnant Women (TP 40).

If a pregnant or postpartum woman loses ongoing eligibility for their current Medicaid coverage, a new TP 40 EDG is created without an application for pregnancy Medicaid. A full redetermination of eligibility must occur at the end of the TP 40 certification period.

Continuous Medicaid coverage is provided through the pregnancy and the 12-month postpartum period regardless of any change in circumstance unless the woman:

  • voluntarily withdraws;
  • moves out of state;
  • dies; or
  • is ineligible due to agency error, fraud, abuse or perjury attributed to the person.

Unverified Pregnancy

When a recipient loses MEPD eligibility, and pregnancy information is received through an interface, the woman is automatically certified for TP 40 with postponed verification and Form H1020, Request for Information or Action is sent. If verification is provided, the woman is eligible for TP 40 coverage through her pregnancy and postpartum period. If verification is not provided, or shows the woman does not meet eligibility requirements, TP 40 coverage is terminated unless the woman is under 19 years old.

Children Under 19

If pregnancy verification is not provided by the 30th day, TP 40 coverage is terminated and the MEPD type of assistance is re-established based on continuous eligibility for children under 19 policy.

If a child who is certified on CHIP during their pregnancy or postpartum period becomes eligible for SSI, MEPD Facility, or MEPD Non-Facility TOA, the CHIP coverage is terminated to allow the transition to SSI, MEPD Facility, or MEPD Non-Facility TOA. The household will receive a denial notice showing the child is not eligible for CHIP for the remainder of their pregnancy and 12-month postpartum period because they are eligible for Medicaid.

Related Policy

Continuous Medicaid Coverage, B-6600
Pregnancy and 12-Month Postpartum Coverage After SSI Denial, B-7120