Chapter XII-Pregnancy Services

VIII. Financial Resources

One of the primary problems for an individual faced with an unexpected pregnancy may be the financial burden imposed. The expectant parents, both mother and father, are expected to assume financial responsibility, in accordance with their ability to do so, for living arrangements, medical care, boarding care and other expenses for the mother and the child. If the mother decides to release the child for adoption, the parents' financial responsibility for the child ends when the child is accepted for adoption planning by an authorized agency and Parental Rights are relinquished.

Neither SSBG (Title XX) nor the State Maternity Fund provides funds for hospitalization and delivery expenses, or other pre-natal medical services received outside the auspices of a maternity home. Parents of an expectant mother may find that their resources cannot handle these unexpected expenses. A woman who has been supporting herself may suddenly be unable to continue her job, or be forced to resign. The caseworker must be prepared to explore with the expectant mother and others involved with the unplanned pregnancy, all financial resources that may be available in supporting the expectant mother's decision about the pregnancy. Some of the possible resources may be:

A. Relatives

Some clients may prefer not to ask their parents for money under these circumstances. Although many parents do everything they can to assist their daughters through a difficult period, they sometimes feel that if they pay the bills, they are entitled to make the decisions. This creates more conflict if the expectant mother is trying to make her own decisions. Some parents are not financially able to help. Alternatively, there may be other relatives who may be able and willing to help. Loans are often easier to obtain from relatives than from finance companies.

B. Private Insurance Coverage

Medical insurance policies vary widely in the type of coverage and amount they will pay. Any existing health insurance policy should be explored for possible benefits. The expectant mother may be covered under her parents' medical insurance, or Tri-Care policy.

C. Employment

More employers are recognizing the right of pregnant women to remain at their jobs as long as the women and their doctors agree they are physically able to do so. Finding a job may be more difficult, particularly if the pregnancy is advanced. Those clients with office skills might be able to find employment through a temporary employment agency. Some maternity homes try to help residents find employment outside the home if clients so desire.

D. Public Assistance

Pregnant women whose family income is no more than 185% of the federal poverty level may be eligible for assistance with medical care through the Medicaid for Pregnant Women (MPW) Program. For purposes of determining income under this program, count the income of the pregnant woman and the income of the expectant father if he is in the home, the pregnant woman states he is the father of the unborn child, and he does not deny paternity. The income limit of the pregnant woman is based on the total number of the following persons: the pregnant woman; the number of children she is expecting to deliver; other children of the pregnant woman if they live in her home; the expectant father if he is in the home; and other children of the expectant father, if he and these children live in the home. No resource test is applied and the client does not have to spend down excess income (deductible) in order to be eligible. Coverage cannot be denied to an otherwise eligible client because she is considering releasing her baby for adoption.

Services to pregnant women under this provision are limited to pre-natal care, delivery, post partum care and services for conditions that may complicate the pregnancy. Services continue throughout the pregnancy and up to sixty days post-partum. Assistance may be retroactive for up to three months so long as it does not precede the month pregnancy began. Since only pregnancy-related services are covered under this program, the client may opt for regular Medicaid (with a deductible) if she desires a wider scope of services. Application for MPW and regular Medicaid must be made with the department of social services in the client's county of residence.

Additionally, “presumptive eligibility” determinations may be made by “qualified providers.” Qualified providers are generally health departments, rural health clinics and some hospitals. Based on medical verification of pregnancy and the pregnant woman’s statement of income and family composition, the qualified provider can say that she is presumptively eligible for Medicaid. This coverage is for ambulatory pre-natal care only, so that she has coverage for pre-natal while her eligibility for full pregnant woman coverage is being determined. Presumptive eligibility does not cover labor and delivery. The pregnant woman must make application for Medicaid at the county department of social services no later than the last day of the month following the month of the presumptive determination. Contact the Medicaid staff for specific information about Medicaid eligibility, or to refer a client for purposes of making an application for Medicaid.

If the pregnant woman plans to keep her baby, she may be eligible to receive TANF after the baby is born. She must be eligible to be the Payee, and meet relevant eligibility requirements. Each woman who decides to apply should be referred to the appropriate TANF staff. If the new mother receives TANF, she will also receive Medicaid.

The Food Stamps Program is another resource for which some pregnant women may qualify. This program is a federal entitlement program designed to help safeguard the health and well being of low income families. The Food Stamp Program also helps any eligible applicant to receive benefits, so long as s/he meets the required guidelines including income, resources, citizenship, and work requirements.

Application for this program must be made with the county department of social services in the woman's county of residence. See the Food Stamp Program Manual, for further information concerning the eligibility criteria and application process for assistance with Food Stamps.

E. State Maternity Fund (SMF)

1. Nature and Scope

a. The State Maternity Fund (SMF) is supported by State funds, Federal child welfare funds, and federal TANF funds and is administered by the NC Division of Social Services.

b. The SMF is a resource for any North Carolina resident experiencing a unplanned pregnancy, regardless of age or marital status, who is unable to remain in her own home during the pre-natal period and whose financial resources have been determined to be inadequate to meet residential costs in an approved living arrangement.

c. Only county departments of social services or licensed private adoption agencies may apply for SMF for individuals experiencing unplanned pregnancies. The Division of Social Services is responsible for reviewing and approving applications, and for monitoring the services for both the county departments of social services and the private adoption agencies.

d. The SMF may be used to help pay for the cost of residential care in the following prescribed living arrangements:

(1) For individuals 18 years of age or older only, a boarding arrangement jointly approved for a specific client by the Division of Social Services and the referring agency;

(2) A foster family home for children licensed in North Carolina and used in accordance with the license issued for that home;

(3) The home of a non-legally responsible relative in North Carolina jointly approved for a specific client by the NC Division of Social Services and the agency requesting Maternity Home Funds; and

(4) A maternity home licensed by or meeting the maternity home standards of the licensing authority in the state in which the facility is located.

e. SMF assistance may not exceed six months (183 days) including up to two weeks of post partum care for the mother only.

f. The SMF cannot be utilized for hospitalization and delivery services or other medical services received outside the auspices of a licensed maternity home. Medical supervision that is provided by a licensed maternity home is included in the per diem cost of care. All medical services for SMF clients residing in alternate living arrangements must be provided through other resources.

g. The SMF may not be used to pay for residential care for a pregnant minor who is in the protective custody of a county department of social services unless the minor's plan of service requires care in a home other than the one in which she resides. In such cases, a copy of the child’s Family Services Case Plan should be submitted with the application for Maternity Home Funds.

2. Reimbursement Rates

SMF reimbursement rates are approved by the Division of Social Services based on the type of facility or living arrangement in which the placement is made.

a. Payment to a licensed maternity home is based on the per diem cost of care. The per diem rate for each maternity home is adjusted annually in relation to audited expenditures and licensed capacity. A maternity home must maintain a valid license for a one year period and submit a suitable audit statement before the per diem rate is assigned.

b. Payment for care in a licensed foster family home is distributed at the state standard board rate for children in foster care.

c. Payment in the approved home of a non-legally responsible relative or in an approved boarding arrangement will not exceed the standard foster care board rate.

3. Approval Criteria

a. The agency requesting SMF for a client must carry service responsibility as follows:

(1) The county departments of social services will be responsible for services and planning for both mothers and infants for whom they are requesting SMF. When distance precludes providing basic casework services while the client is in an approved SMF living arrangement, inter-county services may be requested from another county department of social services. If casework services are transferred to another county, documentation needs to be placed in the case record.

(2) When a client requests services from one of North Carolina's licensed private adoption agencies, the private agency will be responsible for services and planning in conjunction with the client's receipt of SMF in an approved living arrangement.

(3) Services must include helping the client reach her own decisions concerning the future of her baby and her own future, and continuation of services to the infant and/or the mother after SMF payment ceases.

b. Since the SMF is a supplement to other resources, the agency requesting SMF must make a complete exploration of all financial resources available to the client. The agency must establish that resources from the client, her family, the expectant father, significant others, the agency, and other organizations are not adequate to meet residential costs.

4. Application Process

a. Application for the SMF must be made in writing and the original submitted to the SMF Coordinator, Family Support and Child Welfare Services Section, Division of Social Services. Applications should be made as far in advance of the anticipated date of admission to the substitute residential care arrangement as possible. This will allow time for review of the application, and for a decision to be made regarding approval. Applications should not be delayed because the actual admission date has not been confirmed. The service agency must notify the Division of Social Services when the admission date is confirmed so that review and action on the application can be completed. Applications with incomplete information will not be processed.

The Division will make every effort to process applications within five days of the receipt of all necessary information. Funds will not be approved to offset residential costs incurred prior to the Division of Social Services’ receipt of the actual application with original signatures and all information necessary to make a decision regarding approval.

b. If a true emergency admission becomes necessary, the caseworker should telephone the SMF Coordinator prior to admission. With the SMF Coordinator’s concurrence about the need for an emergency admission, the application may be faxed or submitted electronically. In order for approval to be effective on the date of admission, the emergency request must be made as soon as the need for an emergency admission is known. If an emergency admission becomes necessary on a weekend or holiday, the caseworker must telephone the SMF Coordinator on the first working day thereafter. A final decision on the request cannot be made until the SMF Coordinator receives a completed written application with original signatures and all necessary information. It is expected that the completed emergency application will be sent by overnight mail to the SMF Coordinator’s office on the same day that it is submitted.

c. The DSS-6187 Application for State Maternity Funds (Voucher, Social History and Service Plan) is to be used to transmit the required information to the Division of Social Service. This includes the following:

- the reason the client cannot remain in her own home (own home includes a foster care facility in which a child resides);

- information on the client's personal history and family relationships;

- the client's plan for herself and her baby;

- a description of financial resources to be considered and projected residential costs;

- appropriate TANF information including household gross monthly income(s), names and ages of other minor children in household, and statement of US citizenship or immigration status;

- a description of the recommended living arrangement and why it is appropriate;

- the proposed plan of services for the biological parents and the child;

- an explanation of why the necessary services cannot be obtained for the client in a community-based living arrangement

- a tentative agreement to accept the client by the individual responsible for maintaining the recommended living arrangement;

- the anticipated date of admission and the expected date of delivery (month, day, and year for both). It is essential that reimbursement may not exceed the amount initially approved.

Upon receipt of notice that funds have been approved, unless the placement is to be in a licensed maternity home, the agency requesting funds must negotiate with the individual responsible for maintaining the living arrangement a written agreement setting out mutually agreed upon responsibilities. DSS-6189, SMF Residential Care Provider Agreement is to be used for this purpose. (See Section 6050). When the agreement has been completed, a copy of the signed document must be forwarded to the Division of Social Services in order for the Provider to receive SMF reimbursement. No disbursement of the SMF will occur until this document has been completed, signed, and received by the Division of Social Services.

5. Development of Service Plan

The service agency's plan for providing services to the client and her child is to be transmitted to the Division of Social Services as a part of the DSS-6187 Application for State Maternity Fund (Voucher, Social History, and Service Plan).

A structured individualized service plan is the framework around which Pregnancy Services are delivered regardless of whether or not SMF is being requested. A thorough needs assessment done at services intake or by the Pregnancy Services caseworker, in conjunction with alternative counseling (Section 6025 F.), will help identify the prescribed elements of an individualized service plan appropriate for each client requesting Pregnancy Services. If during the process of assessing the needs of a pregnant minor, abuse and/or neglect is suspected, the Pregnancy Services worker should notify the agency's Child Protective Services Unit. After the assessment is completed, the caseworker and the client should jointly finalize a specific plan for services, building in time frames for action and identifying channels for accessing resources to be provided by outside agencies. The same plan can be used to detail services to be provided during and following pregnancy.

As needed and appropriate, the plan should address the following:

− Counseling needs

− Medical Care (Health Dept./Private Physician)

− Medical Assistance (Medicaid/Medically Needy Program for Pregnant Women)

− Nutritional Needs (WIC, Food Stamps, etc.)

− Residential Care

− Housing

− School Attendance

− Employment Training

− Parenting Education

− TANF

− Child Care

− Family Planning

The fact that plans for the client include out-of-home residential care, whether in a maternity home or some other approved living arrangement, increases the need to develop and carry out a structured plan for ancillary services. As a vital part of the application process, service plans are required to be complete to meet the client’s needs. The Pregnancy Services caseworker will be notified when the plan appears to be incomplete and the application will be held for a maximum of 30 days to complete the plan. After 30 days, the application will be considered withdrawn.

While the client is in residential care, the service agency is expected to stay in contact with her and to see that she has the services needed. If she decides to keep her baby, she will likely continue to need a broad array of supportive services. (See Section 6025 F. 3.). If she releases the baby for adoption, the agency's services to the mother and the child will take a different focus. (See Section 6025 F. 2.). At a minimum, regardless of her plan for her child, the mother likely can benefit from Family Planning Services (Family Services Manual Vol. VII, Chapter III, Section 3030) and Individual and Family Adjustment Services (Chapter IV).

6. Guidelines for Assessing the Appropriateness of Alternative Types of Living Arrangements for Individual Clients

A community living arrangement alternative may be the most desirable plan for a client:

− who critically needs ongoing emotional support from members of her family, the expectant father, friends, and other support persons;

− for whom needed supportive services can be appropriately provided by community agencies and resources;

− whose educational program can be continued within the community without interruption;

− for whom strict confidentiality is not an issue;

− for whom residence in a licensed family foster home, the home of a non-legally responsible relative or a boarding arrangement would be more appropriate than in a highly structured group living arrangement;

− for whom one of these appropriate community living arrangements is available.

The Pregnancy Services caseworker is responsible for evaluating the appropriateness of any community living arrangement for which the SMF is requested, whether it is a boarding arrangement, the home of a non-legally responsible relative, or a licensed family foster home.

When residential care in a family foster home is being considered for a minor, the Pregnancy Services caseworker should request the assistance of the Foster Care Services staff in determining whether a home is available, and in assessing the appropriateness of the placement for the pregnant client and for all other persons residing in the home. A decision should be reached by the Foster Care worker and the Pregnancy Services caseworker as to who will assume case management responsibility. If a family foster home is recommended as the choice plan of care, a voluntary placement agreement must be negotiated between the agency requesting SMF and the expectant mother's parent(s) or responsible relative. In instances where the agency applying for SMF has legal custody of the expectant mother, no agreement is necessary; however the child’s Family Services Agreement must be updated to reflect any change in, and appropriateness of, the minor's placement.

The following aspects of a community living arrangement should be explored in determining its appropriateness for individual placements.

a. Location and Surroundings

(1) Is the home readily accessible to resources needed by this particular client; such as medical care, schools, churches, shopping areas, recreational facilities and social services?

(2) Is the home of sufficient size to provide adequate living accommodations for the current residents and this pregnant woman?

b. Physical Environment

(1) Is the home reasonably protected from fire hazards (condition of cooking and heating equipment, wiring)? Are there easy exits on all floor levels? Does the home have a telephone?

(2) Is the house kept reasonably clean, inside and out? Is there proper ventilation? Are the toilet, bathing and laundry facilities adequate?

(3) Are sleeping arrangements appropriate? Will the client have to share a bedroom? Will she have to sleep with someone else? If so, who? Will she be expected to sleep on a sofa or a day bed? Will a place be provided for her personal belongings? Will she be allowed a reasonable degree of privacy?

(4) What is the plan for food preparation? Will the client be expected to cook her own meals, or assist in the kitchen? Will the food provided be nutritionally appropriate for a pregnant woman? If a special diet is recommended for the client by her physician, can it be furnished by the boarding care provider; through food stamps; other resources? Has a plan been developed to help assure nutritional balance for the client through her involvement in the WIC program or another appropriate resource?

c. Emotional Environment

(1) Will exposure to the life style of other residents in this living arrangement or interaction with them, create or alleviate stress for the client? Will the boarding care provider and other residents be able to tolerate any atypical behavior known to be exhibited by the client from time to time? Will individuals in the home attempt to unduly influence the client's decisions regarding plans for herself and her baby?

(2) Is the boarding care provider likely to be alert to emergencies and developing medical or emotional needs of the client, and willing to notify the caseworker and/or the attending physician in accordance with a prearranged agreement?

d. Stability of Living Arrangement

Is the situation of the person responsible for maintaining the living arrangement such that the arrangement can reasonably be expected to remain stable for the duration of the client's pregnancy? Does this individual have realistic expectations of the effect the client will have on the social interaction of other residents?

e. Emergency Transportation

If a medical emergency arises and the client needs transportation immediately, can it be provided by the boarding care provider?

Living arrangements for an expectant mother for whom the SMF is being requested should be selected on the basis of an assessment of the client's individual circumstances and service needs. When alternate placements are found to be appropriate, differences in the cost of care should be taken into consideration when making a SMF recommendation. Placement in a maternity home might be the recommended plan for a client who:

− needs to maintain distance between herself and her family in order to reach decisions without undue pressure;

− needs concentrated casework counseling in a residential care setting outside her community;

− cannot continue her educational program in her own community;

− desires strict confidentiality regarding her pregnancy;

− will likely be able to adjust to and benefit from a structured group living environment.

See Section 6040 for more information about Maternity Homes.

The preceding outline does not reflect an exhaustive series of questions to be answered in determining whether a particular living arrangement should or should not be recommended for an individual pregnant woman. It is intended to prompt the assessing caseworker to realistically consider all pertinent aspects of a proposed living arrangement in relation to identified client needs. A description of the recommended living arrangement is to be transmitted to the Division of Social Services as a part of the Application for State Maternity Fund, DSS-6187 (see Section 6050).

7. Procedure for Approval and Reimbursement

a. All SMF forms, correspondence, and monthly billing statements are to be addressed to the State Maternity Fund Coordinator. The current name, address and phone information for the SMF Coordinator can be found on the most recent change notice for the Pregnancy Services Manual and on the Application for State Maternity Funds (DSS 6187) and it’s instructions.

b. Upon receipt of a satisfactorily completed DSS-6187, the Division of Social Services will make a decision regarding SMF approval for the recommended living arrangement based on individual circumstances. Notice of action taken will be promptly communicated to the appropriate service agency by means of the DSS-6188, Notice of Action on Request for State Maternity Funds, which will also be sent to the Pregnancy Services caseworker, applicable maternity home and the Controller’s Office. The DSS-6188, Notice of Action on request, is non transferable and assigned directly to the maternity care provider.

c. If the approved living arrangement is other than a maternity home, the service agency must submit a completed copy of the DSS-6189, State Maternity Fund Residential Care Provider Agreement, negotiated with the individual responsible for maintaining the living arrangement, to the Division of Social Services before payment will be made to the residential care provider.

d. SMF reimbursement will be limited to actual days of residential care not to exceed the amount initially approved for each client, (maximum of 183 days). At the end of the fiscal year, to the extent funds are reverted due to early deliveries, adjustment in payments to providers will be made to offset losses resulting from unpaid days of care due to late deliveries.

e. At the end of each month, the DHHS Controllers Office, Program Benefits/Payments Section will generate a monthly reimbursement worksheet for each maternity home that details the record of client care including the following information: client's name, date admitted, date discharged, number of days in care that month, and contributions to costs by others, including TANF, families, and SSI. A copy of this worksheet is sent to the maternity home, by the 5th day of the month following service, for verification of data submitted. Any changes or updates made by the maternity homes are made directly to the worksheet. Once the worksheet is verified, an authorized official from the home must certify by signature, in the space provided at the bottom of the worksheet, that all information reported is correct. The worksheet is then mailed to the Division of Social Services for a signature by the SMF Coordinator for approval and submission to the Controller’s office, within five (5) working days of receipt. Reimbursement to the home is then calculated, based on the information identified on the reimbursement worksheet.

f. The DHHS Controller’s office will pay providers directly. The preferred method of payment is electronic transfer. A check will be written each month for each approved living arrangement, as appropriate, and will identify the names of the clients for whom SMF reimbursement is included.

F. State Abortion Fund

1. Nature and Scope

a. The State Abortion Fund is a financial resource for abortion procedures for North Carolina residents who need the procedure and who meet eligibility criteria. This fund is limited to paying for the termination of pregnancies resulting from cases of rape or incest, or pregnancies that endanger the life of the mother.

b. Counseling is an essential element of abortion services and must be provided for all clients who are determined to be eligible for the State Abortion Fund assistance. Please refer to Section VI of this Chapter for additional information on Pregnancy counseling.

c. State Abortion Fund expenditures are limited to the appropriate level authorized by the General Assembly. The Division cannot spend funds from any source in excess of the authorized level.

d. Only abortions performed in accordance with applicable state laws are reimbursable under the State Abortion Fund.

e. Under GS 90-21.7, a physician licensed to practice medicine in North Carolina shall not perform an abortion upon an unemancipated minor unless the physician or agent thereof or another physician or agent thereof first obtains the written consent of the minor. In addition, written consent must be obtained from (1) A parent with custody of the minor; or (2) The legal guardian or legal custodian of the minor; or (3) A parent with whom the minor is living; or (4) A grandparent with whom the minor has been living for at least six months preceding the date of the minor’s consent.
   
Although a County Director of Social Services is the legal custodian of foster children in the director’s respective county, we do not recommend that a director exercise the authority set forth in GS 90-21.7. In such cases, the most prudent course of action is for a director to proceed pursuant to the provisions of GS 7B-903(2) c., which provides that for elective medical or surgical care or treatment for a juvenile in custody, the director should make reasonable efforts to obtain consent from a parent or guardian of the affected juvenile.  In practice, if the juvenile’s parent or guardian cannot be located or refuses to consent to an abortion that is in the child’s best interests, the director should then seek approval and an order from the juvenile court.

2. Eligibility Criteria

a. The client must be eligible for Health Support Services and the client’s need for the abortion must fit one of the following eligibility criteria.

(1). The client is a victim of rape or incest. The statement of the client is acceptable. Documentation in the record must contain at a minimum: 1) the date on which the incident of rape or incest occurred; 2) in a case of rape or incest involving a minor or disabled adult, the date the incident was reported to Children’s Protective Services or Adult Protective Services; 3) whether the incident was reported to another agency; 4) the plan for additional counseling or referral to other resources.

There is no requirement that the incident of rape or incest be reported to any agency or person, except that the county department of social services must assess the situation and determine whether or not the information must be reported in order to comply with other statutory requirements concerning the reporting of adult or child abuse, sexual abuse, molestation or exploitation.

(2). The pregnancy would endanger the life of the mother. There must be a written statement from a physician licensed in North Carolina that clearly addresses the life-endangering nature of the pregnancy. Other conditions, such as “health impairment” will not satisfy this eligibility requirement.

b. Eligibility for the State Abortion Fund is limited to women whose income is below the federal poverty level, as revised annually, and who are not eligible for Medicaid. Title XIX funding (Medicaid) is to be used to fund abortions when the client is eligible, rather than the State Abortion Fund. Therefore a client’s eligibility for Medicaid must be explored and ruled out before authorization of an abortion funded through the State Abortion fund can be considered.

c. Eligibility for the State Abortion Fund will be determined by the county department of social services. The county DSS will provide counseling and family planning services to all clients provided resources under the State Abortion Fund.

d. Due to the limited funds available for the State Abortion Fund, prior approval for all applications must be obtained from the Family Support and Child Welfare Section of the Division of Social Services before completion of the application and authorization by the agency Director or his/her designee.

e. Payments will be made for abortions when the length of gestation as determined by the attending physician is one hundred forty days (140) or less. If there is substantial risk that continuance of the pregnancy would threaten the life or gravely impair the health of the woman, and the length of gestation is over 140 days or 20 weeks, prior approval must be obtained from the Division of Social Services by calling the Family Support and Child Welfare section.

f. Applicants must be residents of North Carolina Applications are made to county departments of social services. A county other that the client’s county of residence may accept an application for State Abortion Funds for individuals who do not want to apply for services in their own counties for reasons of confidentiality.

3. Reimbursement Rates

a. Reimbursement is based on established maximum, all inclusive rates related to the length of gestation and the place of service. Medical Providers may not collect additional funds from the client.

b. Reimbursement for services related to a single abortion procedure cannot exceed the applicable maximum rate regardless of the number of primary and secondary providers involved.

c. Reimbursement will not be made for medical costs incurred by the client in obtaining a physician’s statement to support State Abortion Fund eligibility.

d. Physicians who perform abortions must be licensed by the North Carolina Medical Board or by the comparable regulatory authority in the state where their practice is located.

e. Abortions must be performed in a hospital (inpatient or outpatient), an ambulatory surgical facility or an abortion clinic licensed or certified by the Department of Health and Human Services or by the comparable regulatory authority in the state where the facility is located. A list of certified clinics in North Carolina can be obtained from the Division of Facility Services.

Length of Gestation	Place of Service	Maximum Rate
1 to 12 weeks (1 to 84 days)	Any certified facility; abortion clinic; out-patient hospital; in-patient hospital; or ambulatory surgical facility.	$225.00
13 to 14 weeks (85 to 98 weeks)	Abortion clinic; ambulatory surgical facility; out-patient hospital clinic.	$336.00
15 to 20 weeks (99 to 140 days)	Abortion clinic; ambulatory surgical facility; out-patient hospital clinic.	$382.00
13 to 20 weeks (85 to 140 days)	Hospital in-patient (payment split with all medical providers).	$500.00

4. Application Process

a. The social worker shall determine whether a client is eligible for assistance based on the eligibility criteria.

b. Counseling and referrals must be provided before authorizing an abortion funded through the State Abortion fund.

c. If after the client has been provided counseling, she continues to request State Abortion Fund assistance, the social worker shall complete forms DSS-6211, DSS-6212, and DSS-6847. The social worker is to use service code 385 and program code “N” with the client’s I.D. number to record on the Worker’s Daily Report the time spent completing these forms.

d. Prior approval for all applications must be obtained by calling the Family Support and Child Welfare section of the Division of Social Services prior to completion of the application. You will be given a prior approval number that is to be recorded in the space provided on the DSS-6847 State Abortion Fund Authorization. The Date of the approval and the name or initials of the staff person giving approval shall be recorded in the appropriate spaces on the form.

e. Providers will not be reimbursed for procedures authorized without prior approval. County Departments are advised to keep close track of all authorizations and to contact clients or providers as necessary to insure timely billing.

f. The County Department of Social Services will send forms DSS-6211, DSS-6212 and DSS-6847 to the Division of Social Services, Family Support and Child Welfare Services for payment of authorized services. Incorrect or incomplete forms will be returned and will delay payment.

g. In order to fully utilize limited funds, it will be imperative that corrected authorizations, voided authorizations, and bills for services rendered be received by the County DSS in a timely manner. “Timely manner” means within 60 days of the date of authorization in the case of “voids” or “corrections”, or within 60 days of the date of the procedure when the abortion or an exam is actually performed.