Pregnant Person Only

[EAS 82-836]

When a pregnant person has no other children, a PPO case, formerly an AU of One, may be established for the pregnant person if:

Federal deprivation for the unborn is established, and
Medical verification of pregnancy is provided, and
The person is in any stage of pregnancy, and
The person could not be included in another AU.

Deprivation for the unborn child must be determined using the same criteria for all CalWORKs applications. Deprivation on a PPO application is the lack of parental support for the unborn due to one of the following:

Deceased parent
Absent parent
Disabled parent (if the second parent of the unborn is in the home)
Unemployed Principal Earner (if the second parent of the unborn is in the home) worked less than 100 hours in the 28 days preceding the application and is not expected to work more than 100 hours. The Principal Earner is the parent who received the most earned income in the two years ending with the month before the month of application.

When deprivation does not exist, the application must be denied. The income of the second parent is considered when determining financial eligibility.

Anytime the second parent leaves the home or returns during the pregnancy, deprivation must be established as if the unborn were a child.

“Family”

The “family” consists of the pregnant person and the second parent of the unborn if in the home.

If the second parent of the unborn is in the home:

The second parent will be considered an excluded AU member until the baby is born.
If the second parent has income, both the income and the needs of the second parent will be included in the Family MAP determination for the CalWORKs grant. The actual grant for the PPO will be the lesser of either the Family Grant or AU Grant.

Example Example

The second parent of the unborn is in the home with the pregnant person at application. The second parent is the Principal Earner and unemployed receiving $250.00 per month in UIB.

Family MAP Determination

Family Grant	AU Grant
Family Size: 2	Family Size: 1
$696	$550
+ 47	+ 47
=743	=597
-250	-250
$493	$347
The grant for the PPO is $347.

Note: If the second parent of the unborn is in the home and eligible for RCA, the second parent must be assisted in a separate RCA case until the child is born. Since the pregnant person and the second parent have separate cases and are not part of the same AU, their income/grant does not impact each other’s cases. When the child is born, the second parent must be added to their child's CalWORKs case (MPP 82-832.1c).

Medical Verification

Medical verification is a written statement from a physician, physician's assistant, state certified nurse midwife, nurse practitioner or assigned medical or clinic personnel with access to the patient's medical record, that provides information sufficient to substantiate the diagnosis and the estimated due date. The due date is also known as the EDC.

Effective July 1, 2022, per ACL 21-140, authorizes all PPO applicants to initially satisfy the pregnancy verification requirement by means of a sworn statement or, if necessary, a verbal attestation.

A PPO applicant who cannot provide a medical verification of pregnancy at the time of application shall be allowed to submit a sworn statement, signed under penalty of perjury, to verify the pregnancy for aid to be authorized. Acceptable sworn statements shall include the following:

Applicant’s name,
date of application and
declaration of pregnancy.

When an applicant is unable to provide a sworn statement, a verbal attestation, along with the signed Statement of Facts, shall be accepted. The eligibility conditions under which the PPO applicant verbally attests must be documented within the case narration.

Medical Verification 30 Working Day Follow-Up

Applicants who provided a sworn statement/verbal attestation are required to provide medical verification of pregnancy within 30 working days following the submittal of the sworn statement/verbal attestation for benefits to continue. Aid may only be continued when the individual provides medical verification of pregnancy or presents evidence of a good-faith effort to comply with this requirement. If there is no evidence of good-faith efforts to comply, aid shall discontinue at the end of the month of the 30 working day period with a timely and adequate notice. If benefits continue beyond the end of the month of the 30 working day period, an overpayment must be established for any subsequent aided months the pregnant person failed to comply.

Important: Do not include weekends and holidays when calculating the 30 working days.

Example Example An applicant provides a sworn statement declaring pregnancy on 12/12/2023. The medical verification of pregnancy is due on 1/26/2024, due to weekends and the following approved holidays: 12/25/2023 (Christmas Day), 1/1/2024 (New Year’s Day), and 1/15/2024 (Martin Luther King Jr. Day).

Note: PPO applicants who are also applying for IN and or HA may utilize the same verification flexibilities to be determined apparently eligible for IN and HA.

Pregnant Person in an Existing AU

A PPO case cannot be established for an eligible child in an existing AU. For example, a pregnant 17-year-old living with parents who are already receiving CalWORKs for other children, is an eligible child in the parents' case. Therefore, the pregnant teen CANNOT be aided in a PPO case.

Cal-Learn Teen Pregnant Person Only

A pregnant Cal-Learn teen with no other children in a PPO is federally eligible for CalWORKs during the entire pregnancy. The Cal-Learn teen:

Receives the Cal-Learn Pregnancy Special Need for the entire length of the pregnancy.
Will usually be paid as a “Non-Exempt” AU.

Child Born Later Than Expected

If the child is born in a month later than expected, there is no change needed in the claiming. The pregnant person remains federally eligible even though a late birth could result in claiming five months as federal.

When the child is born, the following steps must be taken:

Determine if both the newborn and the second parent will be added at the same time or at separate times.
1. When adding the newborn results in an increase to the grant amount, the newborn will be added the first of the month after the birth is reported and all conditions of eligibility have been met. If the pregnant person has been receiving a PSN payment:
  1. Discontinue the PSN at the end of the month the birth is REPORTED, and
  2. Add the newborn to the AU the first month AFTER the PSN has ended.
2. When adding the newborn results in a decrease to the grant amount, the newborn will be added the first day of the next SAR Payment Period and after all conditions of eligibility have been met. If the pregnant person has been receiving a PSN payment:
  1. Discontinue the PSN at the end of the SAR payment period, and
  2. Add the newborn to the AU the first month after the payment period
3. When adding the second parent results in an increase to the grant amount, the second parent will be added the first of the month after the birth is reported and all conditions of eligibility have been met.
4. When adding the second parent results in a decrease to the grant amount, the second parent will be added the first day of the next SAR Payment Period and after all conditions of eligibility have been met.
5. Secure the appropriate Statement of Facts to add the newborn and the second parent (if in the home) to the AU.
6. Use a CW 8 if the second parent was included on the SAWS 1 and the SAWS 2 when the pregnant person applied for aid.
7. Use a CW 8A if only adding the newborn child.
8. Use a SAWS 2 if adding both newborn and the second parent and if the second parent was not in the home during the pregnancy.
9. All eligibility requirements must be established.
10. Note: Anytime the second parent leaves the home or returns during the pregnancy, deprivation must be established as if the unborn were a child.
Secure the verification of the birth of the child.
Advise the parent to apply for a Social Security Number for the newborn, if the application hasn't been done so previously. Refer to Eligible Child for information on Social Security Number applications for newborns.
Send a timely Notice of Action to discontinue the pregnancy special need the month before the newborn is to be added to the AU.
If all other eligibility conditions have been met and verified, and the AU reported the birth timely, but no later than on the next SAR 7 subsequent to the birth, the newborn and second parent are entitled to cash-linked Medi-Cal effective the month of birth.

Death of an Unborn Child

Should the pregnancy end prior to the estimated delivery date, not resulting in the birth of a child, CalWORKs recipients are required to report, verbally or in writing, within 30 days following the end of their pregnancy.

For PPO recipients, aid shall discontinue at the end of the month following the month in which the loss was reported with a timely and adequate notice. Prior to discontinuing aid, information about, and referral to, mental health services shall be provided to the recipient when appropriate.

Should the PPO recipient fail to report the loss within 30 days and benefits continued, an overpayment shall be established for any subsequent aided months the pregnant person failed to comply.

Death of a Child at Application

Use the following chart to aid with the application processing at Intake when the applicant reports that a CalWORKs applicant child has died.

If the AU has...	Then the application is...
One eligible Child,	Denied for linkage due to having no eligible child in the home.
Multiple eligible children in the AU,	Processed for the remaining eligible children in the AU removing the deceased child.