A child born to a woman who is receiving MA 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 CIS/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 an MA or CHIP mother is automatically eligible for MA or CHIP 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 mother, does not remain a member of the mother’s household, or the mother is no longer eligible for MA.
NOTE: An adopted newborn, born to a birth mother on MA or CHIP 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 his
or her 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 mother and the newborn’s whereabouts are known, the CAO should open the newborn in its own case record and list the guardian or caretaker as the payment name.
EXAMPLE: A
pregnant woman active on MA gives birth to a newborn. After
bringing the newborn home, the mother decides she is not ready to care
for a baby. The mother
allows the newborn to reside with a family friend. The
newborn no longer resides with the mother, but the newborn is to remain
on MA until age one even though the newborn is not residing with his/her
biological mother.
Newborns that are initially eligible for MA or CHIP because their mother 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.
A
newborn child born to a woman receiving free or low-cost CHIP should
first be screened for MA eligibility
.
EXAMPLE: A
pregnant 16-year old is on CHIP and her eligibility is based on her parent’s
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 mother
has no income. The
newborn is eligible for MA and should not be enrolled or referred to CHIP.
CHIP Contractor Responsibilities
The CHIP contractor receives notification of birth of the newborn and screens the newborn for MA.
If the newborn is determined eligible for MA, the CHIP contractor will complete a referral through Healthcare Handshake (HCHS). The newborn should be listed as the only individual applying for MA. All other CHIP household members will be listed on the referral as not applying.
When
the HCHS referral is made, the CHIP contractor should notify the CAO
CHIP contact person (via email) that a referral for a newborn has
been made through HCHS.
CAO Responsibilities
The CAO will pull the MA newborn referral immediately and expedite the MA opening. CHIP will cover the newborn from the date of birth to the day before the referral is made to DHS. The CAO will open MA for the newborn beginning the date of referral. The CAO has five working days to open MA for the newborn.
The CAO should include all family members listed on the CHIP referral and COMPASS summary when processing the referral. The newborn should be the only individual applying for MA.
If the mother of the newborn
is unemancipated and still under the care and control of her parent,
then the grandparent of the newborn is to be used as the payment name
on the record.
NOTE:
If the information
on the CHIP referral is not sufficient to open MA for the newborn,
the CAO will contact the family to obtain the information and
immediately open MA for the newborn.
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 April 25, 2023, Replacing March 12, 2021