In its 2019 Legislation Session, the Maryland General Assembly passed SB 36/HB 127 creating a Special Enrollment Period (SEP) for individuals who become pregnant and are not eligible for Medicaid. The 90 day SEP begins from the time the woman discovers she’s pregnant. As originally passed, the Bill required confirmation of pregnancy by a health care practitioner and made enrollment effective the first of the month in which pregnancy was confirmed.
A technical amendment is proposed and expected to pass during the 2020 Legislation Session which will make two changes to the original Bill. The first removes the requirement that pregnancy be confirmed by a health care practitioner; instead, pregnancy may be attested to by the applicant and begins the date the applicant finds out she’s pregnant, which might be through a home pregnancy test, a visit to a clinic, recognition of signs and symptoms, or any other means the applicant relies upon.
The second change will allow the enrollment effective date to be chosen between the first of the month in which the consumer attests to acknowledging pregnancy or first of the month in which she applies and makes a plan selection. For example, if the consumer applies on March 20 and attests to finding out she was pregnant on Jan. 25, she may choose between effective dates of Jan. 1 or March 1.
With the proposal of these two amendments, MHBE has chosen to implement the pregnancy SEP as it is expected to be amended and consistent with its legislative goal. These changes will be in production with Rel. 29, scheduled for Jan. 31, 2020. Please refer to Rel. 29 notes for more details. (Consumers eligible before that date will be handled on a case by case basis through a manual work-around.)
If a consumer is already enrolled and becomes pregnant, this SEP will open a new plan shopping opportunity. Since the consumer is already enrolled, the effective date of the new plan will follow the 15 of the month rule. For initial applications, the SEP opens for the pregnant member of the household only; for change reports, the SEP applies to the pregnant woman and current enrollees only. It does not provide an opportunity for the non-pregnant household members to newly enroll in coverage.