The Social Security Act 1902 (e)(4) provides automatic Medicaid eligibility to newborns.
13 CSR 40-2.260 provides that newborns of a woman eligible for Title XIX (Medicaid known as MO HealthNet in Missouri) on the date the child is born are deemed to have filed an application and been found eligible for Title XIX.
The Omnibus Budget Reconciliation Act of 1990, Section 4603, provides that newborns born on or after January 1, 1991, are eligible for Title XIX, for one year, if they are a member of their mother's household and she remains eligible (or if still pregnant would remain eligible) for MO HealthNet. Missouri Rule 13 CSR 40-2.260 has been amended to provide for this coverage.
The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3 included provisions in section 111, 113, and 211 designed to ensure immediate coverage for newborn babies born to mothers who are enrolled in Medicaid or the Children’s Health Insurance Program.
A child born to a woman eligible for Title XIX MO HealthNet on the date of the child's birth continues to be eligible for MO HealthNet throughout the first year of life. This provision applies in instances where the birth occurred prior to the date of application and the woman was covered by MO HealthNet based on retroactive eligibility. Examples of retroactive eligibility would include a woman whose child is born during the three months prior to the month of application and the woman is determined eligible for the prior quarter after the child's birth, or a child is born in the month of application and the woman is determined eligible for MO HealthNet coverage from the first day of the month of application.
There is no requirement that the child remain in the mother’s household or that the mother must remain eligible for MO HealthNet.
Newborn policy applies to children whose mother was participating, or retroactively eligible to participate, in a federally funded MO HealthNet program identified below:
Exceptions: newborn policy does not apply to children whose mother was:
EXAMPLE: A pregnant woman was approved on April 10 for MHABD spend down. The baby was born May 3. The mother's spenddown was not met until May 9. The child is not eligible for newborn as the mother was not eligible for MO HealthNet on the date of the child’s birth.
If the mother's spend down was met on May 3, the child would be eligible for newborn as the mother would be an eligible for MO HealthNet when the child was born.
Approve the child for MO HealthNet within ten (10) days of being notified the child has been born to an eligible MO HealthNet participant.
NOTE: The child’s birth must be reported prior to adding the newborn to a household.
Newborn coverage does not require an application being filed on the child’s behalf and does not require an eligibility determination for the child. To add a newborn, obtain 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. However, it is preferable to determine the legal name before using Baby Boy or Baby Girl to lessen the possibility of duplicate DCNs.
Identity of the child is considered verified by the parent or guardian's self-attestation for children ages newborn to, but not including, age 16.
When notified of a birth, approve the child for the appropriate program beginning on the child’s date of birth.
Always search for an existing DCN prior to assigning one. DCN’s are assigned to Missouri newborns by the Missouri Department of Health and Senior Services (DHSS) Bureau of Vital Statistics when registering the birth.
Do not assume a DCN has not already been assigned to the child simply because it is a newborn.
If a DCN is assigned to a child using Baby Boy or Baby Girl as the first name, refer to Correcting Information in the Common Area in the MEDES Reference Guide to enter the legal first and middle names for the DCN in the system. DO NOT assign a new DCN.
Self-attestation is an acceptable form of verification to add a baby and begin coverage. However, the baby must be reported prior to adding him/her to the household and beginning coverage. The report of birth can come from:
Refer to 1860.010.05 Adding the Newborn policy section, for information to request when the birth is reported.
Determine the effect of the child's birth on the family's eligibility for other MO HealthNet coverage. When the child is determined eligible under the Newborn program, use the date of birth as the application date to add the newborn as a member of an active Family MO HealthNet or MO HealthNet for Kids case.
NOTE: If the birth of a newborn is reported timely, the effective date of any coverage changes for the household is the newborn's birthdate. If birth of a newborn is not reported timely, the effective date of any coverage changes for the household is the date the birth was reported. (Timely is defined as within 10 days of the child's birth.)
A scheduled reinvestigation is not required. An ex-parte review should be started on a Newborn case the month before the child reaches age 1 to evaluate the child's continuing eligibility for other MO HealthNet programs.
Children who are initially eligible for MO HealthNet as Newborns shall be considered to have provided satisfactory documentation of citizenship and identity when their eligibility is renewed on their first birthday.