If a pregnant woman or qualified child is eligible for Healthy Beginnings, the CAO must approve MA as follows: 55 Pa. Code § 140.1 55 Pa. Code § 140.121
For a pregnant woman.
1. Approve Healthy Beginnings to start on the date when the CAO stamped the signed application or, if submitted by a provider, the earliest date it was signed. For a COMPASS application, use the date the application was submitted in COMPASS or the date of the first treatment or admission if submitted by an MA provider. 55 Pa. Code § 140.124 55 Pa. Code § 140.142
NOTE: If the woman is open for presumptive Healthy Beginnings and there are no other medical expenses, open ongoing MA. If CIS does not allow an update due to the future 45 day close date, then complete a MA opening through application processing. If the woman had other medical expenses not covered under presumptive eligibility, then approve retroactive MA to cover the medical expenses.
2. Send a notice to the applicant telling her that she is eligible.
3. After getting the Newborn Eligibility Form (MA 112) or a notice that the pregnancy has ended:
Update the pregnancy end date in CIS on the pregnancy screen.
Provide an advance notice for the closing of Healthy Beginnings benefits to the mother.
For the newborn child of a pregnant woman who is getting Healthy Beginnings.
1. After getting the Newborn Eligibility Form (MA 112) or a notice that the pregnancy has ended, immediately approve Healthy Beginnings for the newborn starting on the newborn's date of birth. Open PS with program status code 16 in the mother’s Healthy Beginnings applicant/recipient group but under a separate budget (for example, PS2 or PS3). When there is a multiple birth, approve all newborns in the same budget. Open PS with program status code 18 for the newborn if the mother is not eligible for MA because of income.
Reminder: Do not use the MA 112 to approve Healthy Beginnings for the newborn during the mother's 45-day presumptive eligibility period. The newborn is eligible if the mother is eligible. See Section 318.8, Approving Presumptive Eligibility.
2. A renewal is due 12 months from the open date.
NOTE: A renewal is required for ongoing MA no later than the first work day of the week after the qualified child’s first birthday. If the child is not approved for ongoing MA, an Advance Notice is issued notifying the individual that benefits will be discontinued.
3. Provide a notice to the applicant letting her know of the date when Healthy Beginnings eligibility begins. 55 Pa. Code § 140.126
NOTE: A child born to a woman receiving MA or CHIP when the child is born is automatically eligible for MA or CHIP on the date of birth and continues to be eligible for one year. Children's Health Insurance Program Reauthorization Act (CHRIPRA) of 2009
NOTE: A child born to an illegal alien mother whose labor and delivery were covered by MA, even though the mother may be eligible for emergency services only is automatically eligible on the date of birth and continues to be eligible for one year. This also applies to a child born to a lawful-alien mother temporarily admitted to the U.S. whose labor and delivery were covered by MA.
NOTE: Newborns that are eligible for MA or CHIP because their mother was eligible at time of birth are considered to have satisfactory documentation of citizenship and identity by the sole fact of being born in the United States. Proof of citizenship and identity are not required for the newborn at birth or any renewal or application for MA or CHIP in the future.
Reminder: Changes in the mother's family income never affect the infant's automatic eligibility, because if she were still pregnant, the mother would stay eligible even if her income changed.
4. Process the MA 112, if it has been received. (See Chapter 338, MA Benefits.)
5. If an application for continued MA benefits is received, consider eligibility for continued Healthy Beginnings, NMP, or MNO.
For a qualified child
1. Approve Healthy Beginnings for each child to start on the date when the CAO stamped the signed application or, if it was submitted by a provider, on the date it was signed. For a COMPASS application, use the date the application was submitted in COMPASS or the date of the first treatment or admission if submitted by an MA provider. All eligible Healthy Beginnings children who are in the same applicant/recipient group and fall within the same income eligibility limits must be in the same PS budget (program status code 16). A Healthy Beginnings pregnant woman must be in a separate PS budget.
NOTE: The Healthy Beginnings applicant who also meets the eligibility rules for the Healthy Horizons program must be included in the eligibility decision for MA for the other members in the household who are applying for or getting MA according to which is more helpful to the other members. The applicant or recipient who meets eligibility requirements for both Healthy Beginnings and Healthy Horizons must choose one coverage group when deciding whether the other family members are eligible for MA. If the applicant or recipient chooses Healthy Horizons, the Healthy Horizons client is not included in the MA eligibility decision for the other members. If the applicant or recipient chooses Healthy Beginnings, the Healthy Beginnings client is treated according to the rules of the MA program that the other family members are applying for or getting.
Example: A pregnant woman and her two children, ages 1 and 3, apply for MA. The entire family is eligible for Healthy Beginnings. The two children are opened in PS (program status code 16), and the pregnant woman is opened in PS2 (program status code 16). When the woman gives birth, the newborn is opened in a separate PS budget (PS3). At the one-year renewal for the newborn, the PS3 budget is closed and the newborn is added to the PS budget.
2. Enter a renewal due date of either the last day of the 12th month from the application date or the date when the child reaches an age that requires a decision on eligibility based on a different income level. 55 Pa. Code § 140.111 55 Pa. Code § 133.23(a)(1)(v)
3. Complete the renewal using the right income limits.
4. If eligibility for PS ends, decide on the eligibility of the child for NMP or MNO benefits. A new MA application form is not required. Enter a renewal date of 12 months from the last MA application form.
NOTE: If other MA budgets are open at the time of the PS 16 renewal, run a renewal for all MA budgets and align the renewal due date.
5. Provide an advance notice that Healthy Beginnings will be closing. If other MA is approved with less benefits, an advance notice will be sent for the approved category. 55 Pa. Code § 133.4(b)
NOTE: A qualified child who is receiving inpatient hospital care at the time he or she goes over the age limit continues to be eligible for Healthy Beginnings until the end of the hospital stay, as long as the family is eligible on the basis of income.
Updated February 14, 2012, Replacing October 13, 2009