Pregnant Minors

Verification

A minor does NOT need to provide pregnancy verification for Minor Consent.

Unmarried Father

If an unmarried minor mother is living with the father of the unborn, DO NOT add the unmarried father to the minor mother’s Minor Consent case.

If the unmarried father is requesting Medi-Cal for himself and/or his other mutual or separate child(ren), then a separate case must be opened with minor mother as Not Requesting Medi-Cal. Minor mother will be an ineligible member in the case.

The EW must first evaluate all members (except minor mother) in the case for MAGI Medi-Cal. If ineligible for MAGI Medi-Cal, then evaluate for Non-MAGI Medi-Cal. If there is a SOC, then apply Sneede v. Kizer rules.


ExampleExample

A pregnant 16-year-old, living with her parents, is applying for Minor Consent. The father of the unborn (17 years old) is also requesting Medi-Cal and is residing with minor mother. He is also employed. There will be 2 separate cases in this scenario. The pregnant 16-year-old will have her own separate Minor Consent case (no one else will be in her case). The 2nd case will be both unmarried minor parents, but the pregnant 16-year-old minor will be Not Requesting Medi-Cal. She will be an ineligible member in the 2nd case.

 

Note: If an unmarried father is requesting Minor Consent, then he must have his own separate case. DO NOT add the minor mother or newborn to his Minor Consent case.

Newborn

Once the child is born, the newborn must be in a separate case from minor mother’s Minor Consent case. DO NOT add the newborn to minor mother’s Minor Consent case.

  • If the newborn is only living with the minor mother (father is not in the home), the minor mother will be Not Requesting Medi-Cal and an ineligible member in the newborn's separate case.
  • If the father of the unborn child is NOT living with minor mother, then the newborn (common child) must be in his/her own separate case.
  • If the father of the unborn child is living with minor mother and he has his own separate case, then the newborn (common child) must be added to the father’s case.
  • The minor mother's unborn can also be included in the senior parent's case if the senior parent(s) are aware of the pregnancy.

Pregnant Minor Needing Services Other Than Pregnancy Services

Pregnant minors requesting Minor Consent pregnancy services receive the zero SOC pregnancy aid code 7N. If the pregnant minor requests services outside the scope of those provided under aid code 7N, two Minor Consent aid codes will be necessary.

No Share of Cost

ExampleExample

A 13-year-old pregnant minor applies for Minor Consent services. The EW approves Minor Consent using aid code 7N for pregnancy related services. The minor also requests mental health services with appropriate documentation. The EW approves the other Minor Consent service using aid code 7P. Only one MC 4026 is required and only one NOA is issued as both programs are zero SOC. One paper BIC must be issued.

Share of Cost

ExampleExample

A pregnant minor applies for Minor Consent services. The EW determines that she is eligible but due to her income she would have a SOC. The EW approves Minor Consent using aid code 7N with zero SOC as the minor is requesting pregnancy related services. The EW also approves the other Minor Consent services under the appropriate aid code with the appropriate SOC. One MC 4026 is required; however, two NOAs are necessary because one program has a SOC and the other no SOC. One paper BIC must be issued.

Continued Eligibility

Continued Eligibility (CE) rules apply to Minor Consent mothers and Deemed Eligibility (DE) rules apply to their newborns.

Mothers

Any increase in the minor mother's income is not counted in her SOC determination for pregnancy related services. However, she must have met her SOC (if applicable) at least once during her pregnancy, in order to qualify for CE.

Infants

An infant born to a Minor Consent mother is entitled to DE benefits.

A separate case must be created for the newborn with minor mom as the Head of Household and case applicant. The minor mom will be an ineligible member in the child’s separate case.


The EW will need to obtain the following:

  • The newborn’s name, date of birth, and gender.

Note: An SSN is not required until the child reaches 1 year old.

  • A Single Streamline Application (CCFRM 604) or Statement of Facts (if none is on file).

 

Reminder: The newborn is exempt from income increases until he/she turns 1 year old.

Postpartum Benefits

A Minor Consent client is entitled to zero SOC postpartum benefits for 60 days after her pregnancy ends. She is not required to file a separate application.

The EW must explain that the client is entitled to postpartum benefits, but the client must request to receive postpartum benefits.

Issue 60-day postpartum benefits according to the chart below:

Postpartum Benefits

If the minor...

Then the EW must...

Received Minor Consent benefits with zero SOC in the month her pregnancy ends,
  • Advise the client of postpartum benefits, including family planning services.
  • When the minor requests postpartum benefits, submit an SCD 1296 to the CST to extend Minor Consent benefits for another month. (An MC 4026 is not required.)
  • Hand-issue a NOA.

Received Minor Consent benefits with a SOC, and meets her SOC in the month pregnancy ends,
  • Issue zero SOC postpartum benefits under aid code 7N (An MC 4026 is not required, but the minor must request these benefits.)
  • Due to Minor Consent confidentiality, issue aid code 7N as an immediate need paper BIC.
  • Hand-issue a NOA.

 
A Minor Consent recipient may continue to need Medi-Cal for family planning services once her pregnancy has ended. Advise the minor that these services are available under Minor Consent aid codes 7M, 7P, or 7R.

Related Topics

Minor Consent

Eligibility Criteria