A child born to a woman who is receiving MA or CHIP on the date of the child's birth automatically receives MA coverage for one year.
The newborn does not need an MA application. The hospital, the parent or another good source can let the CAO know of the baby’s birth. The CAO can then approve MA to start on the day the baby was born.
To make sure a newborn starts receiving MA as soon as possible after birth, the DHS has a liaison (contact person) for providers at each CAO. After the CAO learns of the child’s birth, the liaison makes sure that MA is approved quickly and lets the medical provider know the child’s recipient number and related billing information.
Providers will submit a COMPASS Newborn Add Ticket or an MA 112 form to the CAO within three working days after the child's birth. If an MA 112 is received, the CAO will return the completed forms to the providers within three working days after receiving it.
If a bill is received for newborn services for a child who is not in e-CIS, the system will display a “baby alert.” The CAO will respond to the alert by approving MA for the newborn, effective on the child's date of birth.
NOTE: See Chapter 338, Medical Assistance Benefits, for additional information about newborn eligibility.
The Children’s Health Insurance Program Reauthorization Act (CHIPRA), effective April 1, 2009, included newborn eligibility provisions that the state’s MA and CHIP programs must follow. Newborn eligibility policies are as follows:
A child born to a mother on MA or CHIP is automatically eligible for MA on the date of birth and remains eligible until age one. A separate application or eligibility determination is not required for the child.
The CAO does not continue eligibility for a newborn who moves permanently to another state.
The CAO should reference the MA category cascade for determining the correct category when adding the newborn.
The newborn is eligible for MA from the date of birth until age one regardless of whether the newborn does not come home from the hospital to live with the parent, does not remain a member of the parent's household, or the parent is no longer eligible for MA or CHIP.
NOTE: An adopted newborn, born to a birth parent on MA is eligible for the automatic one year MA or CHIP eligibility.
If the adoptive parents do not want MA coverage for the newborn but the hospital remains unpaid, the CAO is to open the newborn in its own record from the date of birth to the date of discharge from the hospital and make a request to the adoptive parents to decline MA coverage. Narrate all action in the record.
NOTE: If the adoptive parents are known to the CAO and are receiving other benefits in an open case record then the newborn must be opened in the existing case record.
If the CAO is aware that the newborn was adopted, but the CAO does not know the adoptive parents, the CAO is to authorize a period of Non-continuous Eligibility (NCE) for the newborn in the newborn's own record. The NCE will begin on the date of birth and end on the date of discharge from the hospital. The CAO will suppress the eligibility notice. if the adoptive parents eventually contact the CAO and still want the newborn covered under MA then the CAO is to open the newborn for the automatic one year of coverage from the date of birth, narrate all actions in the record.
NOTE: If a newborn does not go home with the birth parent and the newborn’s whereabouts are known, the CAO should open the newborn for MA in its own case record and list the guardian or caretaker as the payment name.
EXAMPLE: A pregnant individual active on MA gives birth to a newborn. After bringing the newborn home, the parent is not ready to care for a baby and allows the newborn to reside with a family friend. The newborn no longer resides with the individual, but the newborn is to remain on MA until age one even though the newborn is not residing with the newborn's biological parent.
Newborns that are initially eligible for MA because their parent was receiving MA or CHIP at the time of birth are considered to have satisfactory documentation of citizenship and identity by the sole fact that they were born in the United States. Citizenship and identity documentation is not required at birth or at any renewal or application for MA or CHIP thereafter.
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EXAMPLE: A pregnant 16-year old is on CHIP and eligibility is based on the pregnant 16-year old's parents' income. The baby is born and the parental income used to determine CHIP eligibility for the 16-year old is not used in an MA eligibility determination for the newborn. The 16-year old has no income. The newborn is eligible for MA and should not be enrolled in CHIP.
309.22 Authorizing a Newborn in eCIS
When opening the newborn and encountering the Individual Attributes screen in eCIS, the CAO will put a check mark on the Individual Attributes Screen in eCIS for the newborn under the following:
With parent since birth.
Received MA or CHIP at Birth.
NOTE: These two questions must be check marked in eCIS in order for the newborn to cascade to a MG 18 N category.
Set the renewal month to the last day of the month of the newborn’s birth.
EXAMPLE: If the child is born on May 10 the renewal date will be May 31 of the following year.
The newborn is eligible for MA until the first birthday. When the child reaches age one, the CAO will process a renewal to determine if the child remains eligible.
Updated March 4, 2025, Replacing June 25, 2024