1 Presumptive Eligibility for Pregnant Women

Medicaid and CHIP Program (MACPro) (CMS-10434)

QSSI-MACPro-PRA-S28T

GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility

OMB: 0938-1188

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

Medicaid and CHIP Program (MACPro)
S28T-Presumptive Eligibility for Pregnant Women
PRA document
Version 1.0
08/21/2017

Document Number: 232-QSSI-MACPro-PRA-S28T-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S28T-Presumptive Eligibility for Pregnant Women – Screenshots ..................... 1
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Presumptive Eligibility for Pregnant Women ................................................... 1

List of Figures
Figure 1: Presumptive Eligibility for Pregnant Women – 1 .............................................. 1
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Figure 3: Presumptive Eligibility for Pregnant Women – 3 .............................................. 2
Figure 4: Presumptive Eligibility for Pregnant Women – 4 .............................................. 3

S28T-Presumptive Eligibility for Pregnant Women PRA document Version 1.0

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S28T-Presumptive Eligibility for Pregnant Women – Screenshots

1. S28T-Presumptive Eligibility for Pregnant Women –
Screenshots
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Presumptive Eligibility for Pregnant Women

Figure 1: Presumptive Eligibility for Pregnant Women – 1

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S28T-Presumptive Eligibility for Pregnant Women – Screenshots

Figure 2: Presumptive Eligibility for Pregnant Women – 2

Figure 3: Presumptive Eligibility for Pregnant Women – 3

S28T-Presumptive Eligibility for Pregnant Women PRA document Version 1.0

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S28T-Presumptive Eligibility for Pregnant Women – Screenshots

Figure 4: Presumptive Eligibility for Pregnant Women – 4

S28T-Presumptive Eligibility for Pregnant Women PRA document Version 1.0

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