16 Del. Admin. Code § 15000-15200
The section describes the eligibility requirements for the Pregnant Woman Group.
The following words and terms, when used in the context of these policies, will have the following meaning unless the context clearly indicates otherwise:
"Pregnant Woman" means a woman during pregnancy and the post partum period, which begins on the date the pregnancy ends, extends 60 days, and then ends on the last day of the month in which the 60-day period ends.
A pregnant woman must meet the general eligibility requirements described in Section 14000. Exception: A pregnant woman is not required to cooperate in establishing paternity and obtaining medical support.
A woman may apply for Medicaid and be found eligible under the Pregnant Woman Group in the month the pregnancy ends or in a month prior to the month the pregnancy ends (while still pregnant), including during a period of retroactive eligibility.
Self-attestation of pregnancy and the unborn fetus count is accepted unless the information provided is not reasonably compatible with other available information. Other available information may include medical claims that are not reasonably compatible with such attestation.
Financial eligibility is determined using the modified adjusted gross income (MAGI) methodologies described in Section 16000. The pregnant woman counts as at least two family members for the financial eligibility determination. If a pregnant woman is diagnosed with a multiple pregnancy, the unborn fetus count is increased accordingly.
Household income must not exceed 212% of the Federal Poverty Level (FPL).
Once a pregnant woman is determined eligible, she remains eligible throughout the pregnancy and the postpartum period regardless of changes in household income.
Statutory Authority
42 CFR 435.116
42 CFR 435.170
The 12-month postpartum period is a mandatory extension of coverage for women who were determined eligible in the month the pregnancy ends, in a month prior to the month the pregnancy ends (while still pregnant), or who received services while pregnant during a period of retroactive eligibility. A woman cannot apply and be found eligible for the postpartum period alone. Coverage begins on the day the pregnancy ends and continues through the last day of the month in which the 12 months ends.
Undocumented aliens are not eligible for the postpartum period.
16 Del. Admin. Code § 15000-15200
26 DE Reg. 323 (10/1/2022)
26 DE Reg. 952 (5/1/2023)
28 DE Reg. 387 (11/1/2024) (Final)