ARM 37.86.3402. TARGETED CASE MANAGEMENT SERVICES FOR HIGH RISK PREGNANT WOMEN, ELIGIBILITY

(1) A member is eligible for targeted case management as a high risk pregnant woman if: (a) the person is receiving Medicaid or is presumptively eligible for Medicaid; and (b) the member's pregnancy outcome is considered high risk. (2) A pregnancy is of high risk if the member: (a) is age 17 or younger; (b) has medical factors which indicate the potential for a poor pregnancy outcome; (c) abuses alcohol, tobacco, or drugs; (d) has someone in the member's immediate environment who abuses alcohol, tobacco, or drugs; (e) is currently in an abusive relationship; (f) is homeless; (g) has had greater than three residences during pregnancy; or (h) demonstrates an inability to obtain necessary resources and services and the person meets three of the following criteria: (i) has a history of physical or sexual abuse; (ii) has no support system or involvement of a spouse or other supporting person; (iii) has not had a dental cleaning in the last year; (iv) is not educated beyond the 12th grade level or does not have a GED; (v) has a physical disability or mental impairment; (vi) has had no prenatal care before or during the first 20 weeks of gestation; (vii) is a refugee or a migrant worker; (viii) is age 18 or 19; (ix) is over the age of 35; or (x) has limited English proficiency. (3) The member is not eligible for targeted case management services if enrolled in a Medicaid Patient Centered Medical Home (PCMH) program, Comprehensive Primary Care Plus (CPC+), or Health Improvement Program (HIP). (4) Targeted case management services may be delivered to the member, if Medicaid eligibility continues, until the last day of the month in which the 12-month postpartum period following delivery ends.