1 Pregnant Women

Centers for Medicare & Medicaid Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
S28-Pregnant Women PRA document
Version 1.0
08/18/2017

Document Number: 213-QSSI-MACPro-PRA-S28-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S28-Pregnant Women – Screenshot ...................................................................... 1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9

Section A. “Characteristics” ............................................................................. 1
Section B. “Financial Methodologies” and Section C. “Income Standard Used”1
Section D. “Benefits for Pregnant Women” – Path 1 ....................................... 2
Section D. “Benefits for Pregnant Women” – Path 2 ....................................... 2
Section D. “Benefits for Pregnant Women” – Path 3 ....................................... 2
Section E. “Basis for Pregnant Women Income Standard” ............................. 3
Section F. “Basis for income limit for full Medicaid coverage for pregnant
women” – Path 1 ............................................................................................. 3
Section F. “Basis for income limit for full Medicaid coverage for pregnant
women” – Path 2 ............................................................................................. 4
Section G. “Additional Information” ................................................................. 4

List of Figures
Figure 1: Characteristics ................................................................................................. 1
Figure 2: Financial Methodologies and Income Standard Used ...................................... 1
Figure 3: Benefits for Pregnant Women – 1 .................................................................... 2
Figure 4: Benefits for Pregnant Women – 2 .................................................................... 2
Figure 5: Benefits for Pregnant Women – 3 .................................................................... 2
Figure 6: Basis for Pregnant Women Income Standard .................................................. 3
Figure 7: Basis for income limit for full Medicaid coverage for pregnant women – 1 ....... 3
Figure 8: Basis for income limit for full Medicaid coverage for pregnant women – 2 ....... 4
Figure 9: Additional Information ...................................................................................... 4

S28-Pregnant Women PRA document Version 1.0

i

08/18/2017

CMS XLC

S28-Pregnant Women – Screenshot

1. S28-Pregnant Women – Screenshot
1.1

Section A. “Characteristics”

Figure 1: Characteristics

1.2

Section B. “Financial Methodologies” and Section C. “Income
Standard Used”

Figure 2: Financial Methodologies and Income Standard Used

S28-Pregnant Women PRA document Version 1.0

1

08/18/2017

CMS XLC

1.3

S28-Pregnant Women – Screenshot

Section D. “Benefits for Pregnant Women” – Path 1

Figure 3: Benefits for Pregnant Women – 1

1.4

Section D. “Benefits for Pregnant Women” – Path 2

Figure 4: Benefits for Pregnant Women – 2

1.5

Section D. “Benefits for Pregnant Women” – Path 3

Figure 5: Benefits for Pregnant Women – 3

S28-Pregnant Women PRA document Version 1.0

2

08/18/2017

CMS XLC

1.6

S28-Pregnant Women – Screenshot

Section E. “Basis for Pregnant Women Income Standard”

Figure 6: Basis for Pregnant Women Income Standard

1.7

Section F. “Basis for income limit for full Medicaid coverage for
pregnant women” – Path 1

Figure 7: Basis for income limit for full Medicaid coverage for pregnant women – 1

S28-Pregnant Women PRA document Version 1.0

3

08/18/2017

CMS XLC

1.8

S28-Pregnant Women – Screenshot

Section F. “Basis for income limit for full Medicaid coverage for
pregnant women” – Path 2

Figure 8: Basis for income limit for full Medicaid coverage for pregnant women – 2

1.9

Section G. “Additional Information”

Figure 9: Additional Information

S28-Pregnant Women PRA document Version 1.0

4

08/18/2017