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