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Clarification of Assumptive Eligibility for Pregnant Women

 

South Carolina Department of Health and Human Services (SCDHHS) is clarifying that pregnant women applying for Medicaid under Optional Coverage for Pregnant Women and Infants (OCWI) may enter the program under assumptive eligibility provisions.  If a woman declares that she is pregnant, and submits an application, she can be determined Medicaid eligible based on her attestation of income, resources, and citizenship for a 30-day period, while she is given the opportunity to return the necessary verification to determine continued eligibility.  The verification may include:

  • proof of pregnancy from a physician, clinic or hospital;
  • proof of income (see chart below for reference to family income requirements for Medicaid eligibility);
  • proof of citizenship/identity; and
  • other required documentation, such as proof of residency.

 

Optional Coverage For Pregnant Women And Infants
 185% of Poverty Level
March 1, 2012

Family Size Monthly Income Annual Income
1 $1,723 $20,676
2 $2,333 $27,996
3 $2,944 $35,328
4 $3,554 $42,648
5 $4,165 $49,980
6 $4,775 $57,300
7 $5,386 $64,632
8 $5,996 $71,952
Each Additional Member $611 $7,332

For each additional family member, add $7,068 to the annual income.
 Divide by 12 and round up to the next whole dollar for the monthly income.

 

Once approved on an assumptive basis, the pregnant woman will receive a Medicaid card in the mail within five to seven days after her application has been submitted.  Eligibility begins on the first day of the month of application and is guaranteed continued eligibility for a minimum of 30 days.  This is to ensure the pregnant woman has coverage to access prenatal care as quickly as possible.  If the applicant does not return the information requested, coverage will be terminated.

If you have any questions concerning this bulletin, please contact the Division of Policy and Planning at (803) 898-2635.  Thank you for your continued support and participation in the South Carolina Medicaid Program.