0930.010.05 NOTIFICATION OF BIRTH (Newborn)

Notification of the birth can come from the mother, the mother's representative, the hospital, the hospital's representative, or the mother's managed healthcare plan.  Approve the child for Medicaid/MC+ within 10 days of being notified a child has been born to an MC+ or Medicaid recipient.  A signed application is not necessary.

To add a newborn, we need the following:

• mother's name and Medicaid number (DCN);
• the child's name;
• child's date of birth;
• child's race and sex; and
• verification of birth.

If the newborn's full name is not available, it is permissible to use Baby Boy or Baby Girl as the child's first name.  Every effort should be made to determine the name before using Baby Boy or Baby Girl to lessen the possibility for duplicate dcns.

Once notification of the birth is received, take the following steps:

• assign a DCN;
• verify the birth;
• approve the child for an appropriate level of care and eligibility dates.

0930.010.10 Assignment Of DCN

The Department of Health and Senior Services assigns DCNs to infants when registering the birth.  Staff cannot assume a DCN has not already been assigned to the child simply because it is a newborn.

If a DCN is assigned to Baby Boy or Baby Girl, staff should use SUPD screen to correct the name for the DCN in the system.  DO NOT assign a new dcn.

0930.010.15 Verification Of Birth

1. If the hospital calls to notify FSD of the birth and to obtain a DCN, request the case name and DCN of the mother, the child's name, date of birth, race and sex, and a copy of the hospital certificate.
2. If the mother notifies FSD of the birth and does not have verification, call the hospital, physician, or nurse-midwife to obtain the verification and request a copy of the hospital certificate.
3. If notification of the birth is from a managed care plan or Division of Medical Services, it should be treated the same as if the hospital had notified FSD. In this situation it will normally not be necessary to contact the hospital as the plan will have received all of the needed information and verification from them. The hospital should be called if the plan reports the child's name as baby boy or girl to see if the hospital has the actual name.
4. A private organization that normally makes applications as the representative of a client can also act as the hospital's representative to report newborns. If notification is received from one of these organizations, an IM-6AR is not required. A general statement from the hospital authorizing them to notify FSD of children being born to MC+ or Medicaid recipients on the hospital's behalf may be requested. It also would be acceptable to call the hospital to verify the birth when the notification is from one of these organizations.

NOTE:  Do not wait for the copy of the hospital certificate prior to adding the child to the case.

0930.010.20 Approve The Child With Appropriate Level Of Care

Newborns do not have to be added as a level of care “G” on a Newborn case, but must be added at a level of care that provides full Medicaid/MC+ benefits. It would be appropriate to approve the newborn under a MAF case with a “T” level of care or as a “Q” level of care under MC+ since coverage is equivalent. The newborn should be coded as such and eligibility moved to a NEWBORN case if under age 1 when future eligibility determinations result in coverage that is not equivalent to the “G” level of care.

Infants eligible for newborn coverage should not be added to a MC+ case with a CHIP level of care (1, 2, or 3) as there are restrictions with CHIP coverage. If the newborn would be CHIP based on current circumstances, open a Newborn case. The newborn should be added to the MC+ case as an included (Z) individual if adding the child would result in a beneficial change in the other children's eligibility (examples: lowers premium amount for family, changes other children from LOC 1 to LOC Q).

Infants born to MA recipients should have their eligibility established by registering and processing a NEWBORN application. This also applies to MA spend down recipients. The Newborn is eligible for MC+ healthcare for one year regardless of the mother's continued spend down eligibility.

When the mother is no longer receiving MC+ healthcare or Medicaid, notification of the birth is received, and the child is not eligible for another non-CHIP type of assistance, register a “NEWBORN” application in the mother's name and DCN. Use the income figures from the mother's last MPW budget and approve the case. If the mother was not receiving MPW, but was on another form of federally-funded Medicaid, enter zero income figures on the Newborn case and approve.

If notification of the birth of the newborn child is several months after the birth, a Newborn application can be IAPP'd in with the date of notification and the newborn approved beginning with the date of birth, as long as:

• the child is not one year of age,
• the mother was receiving MC+ or Medicaid at the time of the birth,
• the mother has remained continuously eligible for MC+ healthcare (or would have if she were still pregnant), and
• the child has lived with the mother from the time of birth.

0930.010.25  Eligibility Dates

An infant meeting the newborn criteria is eligible back to the date of birth regardless of when the Newborn application is made. The IMU5 system will accept a “G” level of care back to the date of birth as long as the child is not age one or older in the month of approval.